Provider Demographics
NPI:1740248426
Name:CHACHAD, SAIRAH Y (MD)
Entity type:Individual
Prefix:MRS
First Name:SAIRAH
Middle Name:Y
Last Name:CHACHAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:SAIRAH
Other - Middle Name:Y
Other - Last Name:SHIRKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5950 S FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2532
Mailing Address - Country:US
Mailing Address - Phone:863-619-8441
Mailing Address - Fax:863-687-8969
Practice Address - Street 1:5950 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2532
Practice Address - Country:US
Practice Address - Phone:863-688-3550
Practice Address - Fax:863-687-8969
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93169208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272848600Medicaid
FL272848600Medicaid
BC92633040OtherDEA