Healthcare Provider Details

I. General information

NPI: 1841682838
Provider Name (Legal Business Name): CHANEQUA D'ALOISIO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2015
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10-42 MITCHELL AVE
BINGHAMTON NY
13903-1617
US

IV. Provider business mailing address

33 LEWIS RD FL 2
BINGHAMTON NY
13905-1055
US

V. Phone/Fax

Practice location:
  • Phone: 607-762-2990
  • Fax:
Mailing address:
  • Phone: 607-770-0025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number404396
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number696307
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: