=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447196092
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHASTITY CHYLD INCORPORATED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2026
-----------------------------------------------------
Last Update Date | 04/27/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5265 UNIVERSITY PKWY # 101-189
-----------------------------------------------------
City | UNIVERSITY PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34201-3012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-717-1753
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5265 UNIVERSITY PKWY # 101-189
-----------------------------------------------------
City | UNIVERSITY PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34201-3012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-717-1753
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. NORTHERN STAR
-----------------------------------------------------
Credential | MPH DHSC(C)
-----------------------------------------------------
Telephone | 703-717-1753
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2083P0901X
-----------------------------------------------------
Taxonomy Name | Public Health & General Preventive Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------