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General NPI Number Information
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NPI Number | 1962755744
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Entity Type | Individual
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Provider Name | AYESHA FAWAD CHAUDRY M.D
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Gender | Female
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Dates
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Enumeration Date | 10/18/2012
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Last Update Date | 10/29/2021
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Provider Practice Location Address
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Address Line | 105 S BRYANT AVE STE NO108
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City | EDMOND
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State | OK
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Zip | 73034-6399
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Country | US
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Telephone | 405-471-6511
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Fax |
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Provider Business Mailing Address
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Address Line | 105 S BRYANT AVE STE NO108
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City | EDMOND
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State | OK
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Zip | 73034-6399
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Country | US
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Telephone | 405-471-6511
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 6724
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 28932
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35222
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License Number State | OK
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