MEDICARE: UNICA CHASTANET

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
1	163WM0705X	Medical-Surgical Registered Nurse	154342	CT

General Provider Information

NPI Number	:	1700600988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	UNICA CHASTANET

Provider Business Mailing Address
First Line	:	435 PARK AVE
Second Line	:
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-3151
Country	:	US
Telephone Number	:	518-645-8031
Fax Number	:

Provider Business Practice Location Address
First Line	:	435 PARK AVE
Second Line	:
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-3151
Country	:	US
Telephone Number	:	518-645-8031
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2024
Last Update Date	:	11/13/2024

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Directions to “ UNICA CHASTANET ” Practice Location

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