=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013645902
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHANTEL BRENA BRENNAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2022
-----------------------------------------------------
Last Update Date | 02/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2479 BROWNCROFT BLVD
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14625-1431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-348-9886
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2479 BROWNCROFT BLVD
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14625-1431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-450-4766
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | 003099-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------