Provider Demographics
NPI:1215432042
Name:FUREY, CHARUTA GAVANKAR
Entity type:Individual
Prefix:
First Name:CHARUTA
Middle Name:GAVANKAR
Last Name:FUREY
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CHARUTA
Other - Middle Name:PRASAD
Other - Last Name:GAVANKAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:350 W THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4409
Mailing Address - Country:US
Mailing Address - Phone:602-406-3181
Mailing Address - Fax:602-294-8286
Practice Address - Street 1:350 W THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4409
Practice Address - Country:US
Practice Address - Phone:602-406-3181
Practice Address - Fax:602-294-8286
Is Sole Proprietor?:No
Enumeration Date:2018-03-25
Last Update Date:2018-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program