Provider Demographics
NPI:1053304923
Name:CHALYKOFF, JUDITH A (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:A
Last Name:CHALYKOFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:A
Other - Last Name:CHALYKOFF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:10437 MOSS PARK RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-5812
Mailing Address - Country:US
Mailing Address - Phone:407-802-1100
Mailing Address - Fax:407-832-1101
Practice Address - Street 1:10437 MOSS PARK RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-5812
Practice Address - Country:US
Practice Address - Phone:407-802-1100
Practice Address - Fax:407-832-1101
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZME100974207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicare UPIN