Healthcare Provider Details

I. General information

NPI: 1447196092
Provider Name (Legal Business Name): CHASTITY CHYLD INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 703-717-1753
  • Fax:
Mailing address:
  • Phone: 703-717-1753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NORTHERN STAR
Title or Position: CEO
Credential: MPH DHSC(C)
Phone: 703-717-1753