Shivani L. Chudasama, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C011964 Issued in NC

Practice address

5475 Lumley Rd Ste 103
Durham, NC 27703

Phone

(919) 354-0830

NPI assigned

Mar 1, 2017

Last updated

Jan 3, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Oct 1, 2019 through Oct 1, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1488326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546473600000",
    "number": "1487194171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5475 LUMLEY RD STE 103",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277037718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5475 LUMLEY RD STE 103",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "27703",
            "telephone_number": "919-354-0830"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5475 Lumley Rd Ste 103",
            "address_purpose": "LOCATION",
            "city": "Durham",
            "state": "NC",
            "postal_code": "27703",
            "country_code": "US",
            "telephone_number": "919-354-0830 x527",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1415 W Nc Highway 54 Ste 121",
            "address_purpose": "LOCATION",
            "city": "Durham",
            "state": "NC",
            "postal_code": "27707",
            "country_code": "US",
            "telephone_number": "919-401-2933",
            "fax_number": "919-401-2994",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHUDASAMA",
        "first_name": "SHIVANI",
        "middle_name": "L.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-03-01",
        "last_updated": "2019-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P010468",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C011964",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chuanwen Sun, D.M.D., P.a. (Kitt Creek Family Dentistry)
• Saumil Mahendra Chudgar, MD
• Tamar Chukrun, MD
• Marius Ifedioranma Chukwurah, MD
• Aimee Byonghee Chung, MD
• John Chung

• Clinical Social Worker in Durham, NC
• Providers in Durham, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.