Provider Demographics
NPI:1679152177
Name:CHOLLERA, SHREYA PARESH
Entity Type:Individual
Prefix:
First Name:SHREYA
Middle Name:PARESH
Last Name:CHOLLERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 S RECKER RD APT 2083
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-1217
Mailing Address - Country:US
Mailing Address - Phone:909-238-3856
Mailing Address - Fax:
Practice Address - Street 1:808 N MISSION PKWY
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85194-8412
Practice Address - Country:US
Practice Address - Phone:520-426-3639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-03
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD011560122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program