Provider Demographics
NPI:1104864263
Name:KHARODE, CHAULA SUNIL (MD)
Entity Type:Individual
Prefix:
First Name:CHAULA
Middle Name:SUNIL
Last Name:KHARODE
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 1:530 HICKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-3415
Mailing Address - Country:US
Mailing Address - Phone:516-937-3511
Mailing Address - Fax:516-937-1011
Practice Address - Street 1:173 MINEOLA BLVD STE 101
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-2529
Practice Address - Country:US
Practice Address - Phone:516-663-9494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1805062084N0400X, 2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400042619OtherMEDICARE PTAN
NY01836391Medicaid
NYH74666Medicare UPIN