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General NPI Number Information
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NPI Number | 1053116368
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Entity Type | Individual
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Provider Name | AVIANCE CHANTAL PANKEY NP
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Gender | Female
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Dates
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Enumeration Date | 02/19/2025
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Last Update Date | 02/06/2026
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Provider Practice Location Address
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Address Line | 2528 LAS BRISAS DR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23456-4264
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Country | US
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Telephone | 757-689-0334
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Fax | 757-689-0350
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Provider Business Mailing Address
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Address Line | 3600 FOREST DR STE 302
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City | COLUMBIA
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State | SC
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Zip | 29204-4057
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Country | US
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Telephone | 803-699-8887
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Fax | 803-699-8824
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 31042
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 0024192635
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License Number State | VA
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