Healthcare Provider Details

I. General information

NPI: 1801601562
Provider Name (Legal Business Name): CHESILIN SUEK APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 SAINT GEORGE SQUARE CT STE 300
WINSTON SALEM NC
27103-1368
US

IV. Provider business mailing address

2520 VESTAL PKWY E STE 2 #A38
VESTAL NY
13850-2075
US

V. Phone/Fax

Practice location:
  • Phone: 888-279-0002
  • Fax: 833-638-0302
Mailing address:
  • Phone: 702-465-8741
  • Fax: 833-638-0302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number29924
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5022264
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5022264
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: