Provider Demographics
NPI:1538057583
Name:CHAVDA, DHARMENDRASINH P
Entity type:Individual
Prefix:MR
First Name:DHARMENDRASINH
Middle Name:P
Last Name:CHAVDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 W DONNER DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-6696
Mailing Address - Country:US
Mailing Address - Phone:732-513-6646
Mailing Address - Fax:
Practice Address - Street 1:2208 W DONNER DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-6696
Practice Address - Country:US
Practice Address - Phone:732-513-6646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-26
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBHRF20030320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness