Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 295925 | NY |
NPI | 1013440452 |
---|---|
Provider Name | Nastacia Chavannes |
First Address | Bronx, NY 10458-1000 |
Second Address | Bronx, NY 10458-1000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2017 |
Last Update Date | 22/03/2019 |