Healthcare Provider Details

I. General information

NPI: 1235771841
Provider Name (Legal Business Name): CHANTELLE NATASHA DIABATE LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2019
Last Update Date: 10/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 W 125TH ST LOWR LEVEL
NEW YORK NY
10027-4502
US

IV. Provider business mailing address

40A LOCUST HILL AVE APT 3G
YONKERS NY
10701-3028
US

V. Phone/Fax

Practice location:
  • Phone: 212-663-3000
  • Fax:
Mailing address:
  • Phone: 347-392-9328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number321808
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: