Healthcare Provider Details

I. General information

NPI: 1871544643
Provider Name (Legal Business Name): CHANTELL DALPE-FUNG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 03/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

739 IRVING AVE SUITE 530
SYRACUSE NY
13210-1651
US

IV. Provider business mailing address

739 IRVING AVE SUITE 530
SYRACUSE NY
13210-1651
US

V. Phone/Fax

Practice location:
  • Phone: 315-478-1158
  • Fax: 315-478-3014
Mailing address:
  • Phone: 315-478-1158
  • Fax: 315-478-3014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number227581
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: