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General NPI Number Information
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NPI Number | 1568162154
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Entity Type | Individual
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Provider Name | CHANEL ANDERSON
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Gender | Female
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Dates
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Enumeration Date | 03/03/2023
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Last Update Date | 03/03/2023
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Provider Practice Location Address
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Address Line | 694 BEACH 20TH ST
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691-3502
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Country | US
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Telephone | 718-945-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 11640 GUYBREWER BLVD APT 5A
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City | JAMAICA
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State | NY
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Zip | 11434-1143
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Country | US
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Telephone | 516-849-2283
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Fax |
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | NY
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