Healthcare Provider Details

I. General information

NPI: 1669998134
Provider Name (Legal Business Name): MYRIAM CHLELA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2017
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33-57 HARRISON ST
JOHNSON CITY NY
13790-2107
US

IV. Provider business mailing address

33 LEWIS RD FL 2
BINGHAMTON NY
13905-1055
US

V. Phone/Fax

Practice location:
  • Phone: 607-763-6101
  • Fax: 607-763-5180
Mailing address:
  • Phone: 607-770-0025
  • Fax: 607-729-3816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2026-00760
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number309635
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: