Provider Demographics
NPI:1194836676
Name:CHOUDRY, SHEHZAD HAFIZ (MD)
Entity Type:Individual
Prefix:DR
First Name:SHEHZAD
Middle Name:HAFIZ
Last Name:CHOUDRY
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 1:89 W COPELAND DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2002
Mailing Address - Country:US
Mailing Address - Phone:321-841-1570
Mailing Address - Fax:321-841-1569
Practice Address - Street 1:89 W COPELAND DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2002
Practice Address - Country:US
Practice Address - Phone:321-841-1570
Practice Address - Fax:321-841-1569
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005010132084N0400X
NC2005-01013208VP0014X
FLME1417802084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC141C2OtherBCBS NC
NCE4062OtherMEDCOST
NC5901299Medicaid
NCP00298080OtherRAILROAD-MEDICARE
NC806154OtherPARTNERS
FL103694500Medicaid
NC8913923OtherCIGNA
NC8913923OtherCIGNA