Provider Demographics
NPI:1710107271
Name:CHABERT, ASTRID MYRZA (MD)
Entity type:Individual
Prefix:DR
First Name:ASTRID
Middle Name:MYRZA
Last Name:CHABERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5164 CONWAY RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-1252
Mailing Address - Country:US
Mailing Address - Phone:407-770-1414
Mailing Address - Fax:407-447-8876
Practice Address - Street 1:1583 E SILVER STAR RD
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-2553
Practice Address - Country:US
Practice Address - Phone:407-770-1414
Practice Address - Fax:407-447-8876
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ46925208000000X
TXN4979208000000X
FL135103208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX210044801Medicaid
TX210044802Medicaid
TX210044803Medicaid
TX210044804Medicaid