=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649140492
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHARON DIANE CHESTNUT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2025
-----------------------------------------------------
Last Update Date | 11/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 470 ROUTE 211 E STE 2
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10940-2250
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-342-0426
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4 STUHR GDNS APT S
-----------------------------------------------------
City | PEEKSKILL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10566-2516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-342-0426
-----------------------------------------------------
Fax | 845-342-0432
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 156FX1800X
-----------------------------------------------------
Taxonomy Name | Optician
-----------------------------------------------------
License Number | 010723-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------