Provider Demographics
NPI:1326389909
Name:CHOUDHURY, SHARMIN (PA)
Entity Type:Individual
Prefix:MISS
First Name:SHARMIN
Middle Name:
Last Name:CHOUDHURY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SHARMIN
Other - Middle Name:
Other - Last Name:CHOUDHURY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:94-31 LEFFERTS BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11419
Mailing Address - Country:US
Mailing Address - Phone:646-575-3388
Mailing Address - Fax:
Practice Address - Street 1:7506 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11417-1034
Practice Address - Country:US
Practice Address - Phone:718-848-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016234-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY016234-1OtherREGISTRATION LISENCE NUMBER