Healthcare Provider Details

I. General information

NPI: 1508419144
Provider Name (Legal Business Name): ANDREA S CHIK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2019
Last Update Date: 08/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 WEST ST
DANBURY CT
06810-6528
US

IV. Provider business mailing address

124 COALPIT HILL RD UNIT 21
DANBURY CT
06810-8016
US

V. Phone/Fax

Practice location:
  • Phone: 203-748-5689
  • Fax:
Mailing address:
  • Phone: 203-947-9363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number8396
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: