Provider Demographics
NPI:1235141169
Name:CHAUDHURI, MITALI (MD)
Entity Type:Individual
Prefix:DR
First Name:MITALI
Middle Name:
Last Name:CHAUDHURI
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 1:2901 MONTOPOLIS DR
Mailing Address - Street 2:MENTAL HEALTH
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-6411
Mailing Address - Country:US
Mailing Address - Phone:512-389-6552
Mailing Address - Fax:512-389-6544
Practice Address - Street 1:2901 MONTOPOLIS DR
Practice Address - Street 2:MENTAL HEALTH
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741-6411
Practice Address - Country:US
Practice Address - Phone:512-389-6552
Practice Address - Fax:512-389-6544
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK46552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry