Provider Demographics
NPI:1669278230
Name:CHOUDHRY, SONEELA
Entity type:Individual
Prefix:
First Name:SONEELA
Middle Name:
Last Name:CHOUDHRY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 CENTER ROSS RD
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-8205
Mailing Address - Country:US
Mailing Address - Phone:219-671-5329
Mailing Address - Fax:
Practice Address - Street 1:7853 TAFT ST
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5240
Practice Address - Country:US
Practice Address - Phone:219-554-9114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39005334A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health