Provider Demographics
NPI:1043311707
Name:CHAUDHARY, SAJID (MD)
Entity Type:Individual
Prefix:
First Name:SAJID
Middle Name:
Last Name:CHAUDHARY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 HILDA ST
Mailing Address - Street 2:#22
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-2320
Mailing Address - Country:US
Mailing Address - Phone:407-279-5069
Mailing Address - Fax:407-378-3076
Practice Address - Street 1:102 PARK PLACE BLVD.
Practice Address - Street 2:BLDG D, SUITE 2 &3
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-2358
Practice Address - Country:US
Practice Address - Phone:407-279-5069
Practice Address - Fax:407-378-3076
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 90758207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2716381 00Medicaid
FLU3407ZOtherPTAN
FLU3407ZOtherPTAN