=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740856525
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHELSEA MELISSA BEACH FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2021
-----------------------------------------------------
Last Update Date | 11/21/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3 BROOK DR APT 18
-----------------------------------------------------
City | WASHINGTONVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10992-1069
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-238-6098
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15 SUFFERN PL
-----------------------------------------------------
City | SUFFERN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10901-5566
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-357-4500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 755332
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 355104
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------