Provider Demographics
NPI:1053666495
Name:CHOUDHRY-AKHTER, MYRA (MD)
Entity Type:Individual
Prefix:DR
First Name:MYRA
Middle Name:
Last Name:CHOUDHRY-AKHTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6610 N UNIVERSITY DR STE 120
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-4000
Mailing Address - Country:US
Mailing Address - Phone:954-720-6116
Mailing Address - Fax:954-720-3638
Practice Address - Street 1:6610 N UNIVERSITY DR STE 120
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-4000
Practice Address - Country:US
Practice Address - Phone:954-720-6116
Practice Address - Fax:954-720-3638
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-23
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME120941207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015364800Medicaid
FL1513POtherFL BLUE
FLHX491XMedicare PIN