Provider Demographics
NPI:1093372476
Name:CHAUDRY, TALITHA
Entity Type:Individual
Prefix:
First Name:TALITHA
Middle Name:
Last Name:CHAUDRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13008 CLAXTON DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-1804
Mailing Address - Country:US
Mailing Address - Phone:240-595-5646
Mailing Address - Fax:
Practice Address - Street 1:13008 CLAXTON DR
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-1804
Practice Address - Country:US
Practice Address - Phone:240-595-5646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1043362163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse