Provider Demographics
NPI:1922132562
Name:CHAVDA, SHAILENDRA N (MD)
Entity type:Individual
Prefix:
First Name:SHAILENDRA
Middle Name:N
Last Name:CHAVDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 W LYNDON B JOHNSON FWY STE 405
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3710
Mailing Address - Country:US
Mailing Address - Phone:972-993-5080
Mailing Address - Fax:972-993-5081
Practice Address - Street 1:440 W LYNDON B JOHNSON FWY STE 405
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3710
Practice Address - Country:US
Practice Address - Phone:972-993-5080
Practice Address - Fax:972-993-5081
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108095207R00000X
TXN 4342207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX207931103Medicaid
TX207931104OtherMEDICAID - OTHER
TX331569YL7BMedicare PIN