Healthcare Provider Details

I. General information

NPI: 1003365701
Provider Name (Legal Business Name): ELLEANA CHALIL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELLEANA GOLDMAN

II. Dates (important events)

Enumeration Date: 09/23/2016
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4421 STUART ANDREW BLVD
CHARLOTTE NC
28217-1589
US

IV. Provider business mailing address

800 BLACKBURN CT
CHARLOTTE NC
28209-4065
US

V. Phone/Fax

Practice location:
  • Phone: 980-343-6960
  • Fax:
Mailing address:
  • Phone: 631-902-0015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number15376
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: