Provider Demographics
NPI:1497809743
Name:CHAWLA, STEPHANIE SHANNON (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:SHANNON
Last Name:CHAWLA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 HOLLY HILL LN
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-6071
Mailing Address - Country:US
Mailing Address - Phone:203-884-8420
Mailing Address - Fax:833-906-2492
Practice Address - Street 1:81 HOLLY HILL LN
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-6071
Practice Address - Country:US
Practice Address - Phone:203-884-8420
Practice Address - Fax:833-906-2492
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2642363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400091239OtherMEDICARE
NC0179TOtherBLUE CROSS GROUPID #
NC2768966Medicare PIN