MEDICARE: SHAFI K CHOUDHURY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	NY153350	NY

General Provider Information

NPI Number	:	1245392562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAFI K CHOUDHURY MD

Provider Business Mailing Address
First Line	:	14 STONEY HOLLOW RD
Second Line	:
City	:	CHAPPAQUA
State	:	NY
Zip	:	10514-2014
Country	:	US
Telephone Number	:	914-238-3945
Fax Number	:

Provider Business Practice Location Address
First Line	:	234 E 149TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10451-5504
Country	:	US
Telephone Number	:	718-579-5800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	07/08/2007

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