Basic Information
Provider Information
NPI: 1881684074
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHUMBLE
FirstName: SHUBHANGI
MiddleName: ATUL
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9110 COLLEGE POINTE CT
Address2:  
City: FORT MYERS
State: FL
PostalCode: 339193244
CountryCode: US
TelephoneNumber: 2392082212
FaxNumber: 3219517408
Practice Location
Address1: 9110 COLLEGE POINTE CT
Address2:  
City: FORT MYERS
State: FL
PostalCode: 33919
CountryCode: US
TelephoneNumber: 2392082212
FaxNumber: 2392083994
Other Information
ProviderEnumerationDate: 10/27/2005
LastUpdateDate: 11/10/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/10/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084N0400XMD478085PAN Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
2084N0400X19705NHN Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
2084N0400XME120321FLY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology

ID Information
IDTypeStateIssuerDescription
013555200005FL MEDICAID
311930905NH MEDICAID


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