Provider Demographics
NPI:1447508783
Name:CHAUDHURY, SADIA RAHMAN (PHD)
Entity type:Individual
Prefix:DR
First Name:SADIA
Middle Name:RAHMAN
Last Name:CHAUDHURY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 WILLIS AVE # 1
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4408
Mailing Address - Country:US
Mailing Address - Phone:347-433-5382
Mailing Address - Fax:
Practice Address - Street 1:55 WILLIS AVE FL 1
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4408
Practice Address - Country:US
Practice Address - Phone:347-433-5382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY68019690103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical