Provider Demographics
NPI:1427111715
Name:CHOWDHURY, ANWAR (PA PHYSICIAN ASSISTA)
Entity type:Individual
Prefix:MR
First Name:ANWAR
Middle Name:
Last Name:CHOWDHURY
Suffix:
Gender:M
Credentials:PA PHYSICIAN ASSISTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3993 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-9726
Mailing Address - Country:US
Mailing Address - Phone:407-732-4272
Mailing Address - Fax:407-732-4579
Practice Address - Street 1:3993 W 1ST ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-9726
Practice Address - Country:US
Practice Address - Phone:407-732-4272
Practice Address - Fax:407-732-4579
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FLPA9100777363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health