Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 257671 | NY |
N | 2084N0600X | Clinical Neurophysiologist | 257671 | NY |
NPI | 1184935645 |
---|---|
Provider Name | Dr. Gabrielle Marie Chassagne |
First Address | Mineola, NY 11501-2528 |
Second Address | Mineola, NY 11501-2528 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2010 |
Last Update Date | 05/03/2021 |