Healthcare Provider Details

I. General information

NPI: 1962728980
Provider Name (Legal Business Name): CHITRA CHITALE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHITRA SHUKLA

II. Dates (important events)

Enumeration Date: 04/15/2010
Last Update Date: 09/26/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 ATLANTIC AVE STE 108
BROOKLYN NY
11213-1122
US

IV. Provider business mailing address

400 MAMARONECK RD
SCARSDALE NY
10583-7728
US

V. Phone/Fax

Practice location:
  • Phone: 212-876-2300
  • Fax: 212-369-8209
Mailing address:
  • Phone: 914-263-5621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF342922-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: