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General NPI Number Information
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NPI Number | 1730400060
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Entity Type | Individual
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Provider Name | VERONICA LISSETTE CHASTAIN M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/22/2010
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Last Update Date | 11/15/2013
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Provider Practice Location Address
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Address Line | 1749 DAVID WALKER DR
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City | TAVARES
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State | FL
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Zip | 32778-5745
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Country | US
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Telephone | 352-742-1760
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Fax | 352-742-2604
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Provider Business Mailing Address
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Address Line | 1749 DAVID WALKER DR
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City | TAVARES
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State | FL
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Zip | 32778-5745
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Country | US
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Telephone | 352-742-1760
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Fax | 352-742-2604
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 004367
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME117565
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License Number State | FL
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