Provider Demographics
NPI:1508680109
Name:CHOUDRY, AMINA
Entity type:Individual
Prefix:
First Name:AMINA
Middle Name:
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 1:7309 WINTHROP WAY UNIT 6
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-4084
Mailing Address - Country:US
Mailing Address - Phone:630-823-6513
Mailing Address - Fax:
Practice Address - Street 1:3530 GATEWOOD LN
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-3132
Practice Address - Country:US
Practice Address - Phone:630-823-6513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
24-391480106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician