Provider Demographics
NPI:1679646236
Name:NAEELA CHAUDRY PH.D., PA
Entity Type:Organization
Organization Name:NAEELA CHAUDRY PH.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NAEELA
Authorized Official - Middle Name:MAJID
Authorized Official - Last Name:CHAUDRY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:903-361-0486
Mailing Address - Street 1:5321 STONEBRIAR CIR
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-1702
Mailing Address - Country:US
Mailing Address - Phone:903-361-0486
Mailing Address - Fax:903-361-5097
Practice Address - Street 1:321 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-7378
Practice Address - Country:US
Practice Address - Phone:903-361-0486
Practice Address - Fax:903-361-5097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32660103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00700ZMedicare ID - Type UnspecifiedTEXAS GROUP NUMBER