Provider Demographics
NPI:1811365893
Name:CHOUDRY, SAIRA BANO
Entity Type:Individual
Prefix:
First Name:SAIRA
Middle Name:BANO
Last Name:CHOUDRY
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:PO BOX 1165
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-7165
Mailing Address - Country:US
Mailing Address - Phone:516-476-0317
Mailing Address - Fax:302-595-3149
Practice Address - Street 1:1309 SAVANNAH RD
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1514
Practice Address - Country:US
Practice Address - Phone:302-644-1441
Practice Address - Fax:302-595-3149
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC50001019363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical