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NPI Code Detail

MEDICARE: JUSTIN CHANDANA CHAIZE PMHNP

MEDICARE: JUSTIN CHANDANA CHAIZE PMHNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse667469NY
2363LP0808XPsychiatric/Mental Health Nurse PractitionerF404224-01NY

General Provider Information

NPI Number : 1477896413
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTIN CHANDANA CHAIZE PMHNP
Provider Business Mailing Address
First Line : 140 HIBISCUS DR
Second Line :
City : ROCHESTER
State : NY
Zip : 14618-4438
Country : US
Telephone Number : 585-269-0512
Fax Number :
Provider Business Practice Location Address
First Line : 150 MOUNT HOPE AVE
Second Line :
City : ROCHESTER
State : NY
Zip : 14620-1016
Country : US
Telephone Number : 585-257-5626
Fax Number : 585-448-0444
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2013
Last Update Date : 03/15/2024

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