Healthcare Provider Details

I. General information

NPI: 1386093284
Provider Name (Legal Business Name): NICOLE CHAVES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 09/23/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 WASHINGTON ST
HARTFORD CT
06106-3322
US

IV. Provider business mailing address

85 EMERSON AVE
PITTSFIELD MA
01201-7339
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-9200
  • Fax:
Mailing address:
  • Phone: 413-329-2882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: