Provider Demographics
NPI:1528535036
Name:CHAHAL, JASKIRT KAUR (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:JASKIRT
Middle Name:KAUR
Last Name:CHAHAL
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:126 VANIDA LN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-1533
Mailing Address - Country:US
Mailing Address - Phone:770-880-2441
Mailing Address - Fax:
Practice Address - Street 1:1617 N JAMES ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-2852
Practice Address - Country:US
Practice Address - Phone:315-337-0539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant