Healthcare Provider Details

I. General information

NPI: 1245934439
Provider Name (Legal Business Name): SILVANA CHIPOLLINI MSN, APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 10/13/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89-44 164TH ST
JAMAICA NY
11432-6103
US

IV. Provider business mailing address

60 MADISON AVE FL 5
NEW YORK NY
10010-1600
US

V. Phone/Fax

Practice location:
  • Phone: 718-523-2123
  • Fax: 718-523-5833
Mailing address:
  • Phone: 221-545-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11025110
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: