Healthcare Provider Details

I. General information

NPI: 1104754746
Provider Name (Legal Business Name): CHRYSTA GOMES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 WIXON RD
CARMEL NY
10512-5858
US

IV. Provider business mailing address

9 WIXON RD
CARMEL NY
10512-5858
US

V. Phone/Fax

Practice location:
  • Phone: 845-391-4289
  • Fax:
Mailing address:
  • Phone: 845-391-4289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number774845
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: