Provider Demographics
NPI:1669795324
Name:CHODHRY, AMTUL S (PA-C)
Entity type:Individual
Prefix:
First Name:AMTUL
Middle Name:S
Last Name:CHODHRY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7571 MIRAMAR PKWY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-5954
Mailing Address - Country:US
Mailing Address - Phone:954-663-5463
Mailing Address - Fax:954-663-5463
Practice Address - Street 1:7571 MIRAMAR PKWY
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-5954
Practice Address - Country:US
Practice Address - Phone:954-663-5463
Practice Address - Fax:954-663-5463
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102786363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant