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NPI Code Detail

MEDICARE: NAVEEN MOHYUDDIN PA-C

MEDICARE: NAVEEN MOHYUDDIN PA-C
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
12083A0300XAddiction Medicine (Preventive Medicine) Physician3715TN
2363A00000XPhysician Assistant0110006988VA
3363A00000XPhysician Assistant3715TN
4363AM0700XMedical Physician Assistant0110006988VA
52084P0800XPsychiatry Physician3715TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10110006988OTHERVAPA
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1780159699
Entity Type Code : Individual
Provider Name (Legal Business Name) : NAVEEN MOHYUDDIN PA-C
Provider Business Mailing Address
First Line : 1301 EXECUTIVE BLVD STE 200
Second Line :
City : CHESAPEAKE
State : VA
Zip : 23320-3671
Country : US
Telephone Number : 757-312-6754
Fax Number : 757-312-3135
Provider Business Practice Location Address
First Line : 6141 SHALLOWFORD RD STE 100
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37421-1663
Country : US
Telephone Number : 423-498-2000
Fax Number : 423-498-2001
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2018
Last Update Date : 02/19/2026

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Directions to “ NAVEEN MOHYUDDIN PA-C” Practice Location

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