Healthcare Provider Details

I. General information

NPI: 1750290029
Provider Name (Legal Business Name): CHANTALLE LATKO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 ELMWOOD AVE # 326
KENMORE NY
14217-1304
US

IV. Provider business mailing address

1538 98TH ST
NIAGARA FALLS NY
14304-2787
US

V. Phone/Fax

Practice location:
  • Phone: 716-447-6931
  • Fax:
Mailing address:
  • Phone: 716-807-1129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number433754
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: