Healthcare Provider Details

I. General information

NPI: 1932003506
Provider Name (Legal Business Name): CHASTITY CHYLD INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1487 2ND ST STE C3
SARASOTA FL
34236-4911
US

IV. Provider business mailing address

5265 UNIVERSITY PKWY # 101-189
UNIVERSITY PARK FL
34201-3012
US

V. Phone/Fax

Practice location:
  • Phone: 718-288-8224
  • Fax:
Mailing address:
  • Phone: 718-288-8224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: NORTHERN STAR
Title or Position: CEO
Credential: DR
Phone: 718-288-8224