Provider Demographics
NPI:1619458643
Name:DR. CHAUDHRY PLLC
Entity Type:Organization
Organization Name:DR. CHAUDHRY PLLC
Other - Org Name:SOUTH FLORIDA FOOD ALLERGY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ALLERGIST & IMMUNOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RABIA
Authorized Official - Middle Name:QUDDUS
Authorized Official - Last Name:CHAUDHRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-855-1999
Mailing Address - Street 1:500 NE SPANISH RIVER BLVD STE 28A
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-4517
Mailing Address - Country:US
Mailing Address - Phone:561-855-1999
Mailing Address - Fax:
Practice Address - Street 1:500 NE SPANISH RIVER BLVD STE 28A
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431
Practice Address - Country:US
Practice Address - Phone:561-855-1999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-27
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL123352207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019792000Medicaid