Provider Demographics
NPI:1790906923
Name:CHAUDHERY, SHABNUM ILYAS (MD)
Entity Type:Individual
Prefix:DR
First Name:SHABNUM
Middle Name:ILYAS
Last Name:CHAUDHERY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 33932
Mailing Address - Street 2:1501 KINGS HWY
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71130-3932
Mailing Address - Country:US
Mailing Address - Phone:318-675-5860
Mailing Address - Fax:318-675-6444
Practice Address - Street 1:1501 KINGS HWY
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71130-3932
Practice Address - Country:US
Practice Address - Phone:318-675-5860
Practice Address - Fax:318-675-6444
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001229207ZP0102X
LAMD.204957207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology