=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932187499
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHAHID M CHAUDHARY M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2006
-----------------------------------------------------
Last Update Date | 11/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | ROCHELAISE CENTER, WESTERN INDUST PARK. OFICINA 3B CARR 114, KM 0.4
-----------------------------------------------------
City | MAYAGUEZ
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00680-0068
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-412-7805
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 99 CALLE PALENCIA, URB. SULTANA
-----------------------------------------------------
City | MAYAGUEZ
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00680-4633
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-673-1238
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | 19793
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------