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General NPI Number Information
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NPI Number | 1891452959
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Entity Type | Individual
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Provider Name | ANISHA SARA CHACKO NP
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Gender | Female
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Dates
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Enumeration Date | 11/23/2021
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | 55 2ND AVE UNIT 2
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City | BRENTWOOD
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State | NY
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Zip | 11717-4665
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Country | US
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Telephone | 631-983-3237
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Fax | 631-961-8775
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Provider Business Mailing Address
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Address Line | 72 FULTON AVE
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City | HEMPSTEAD
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State | NY
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Zip | 11550-3651
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Country | US
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Telephone | 516-559-7880
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Fax | 929-481-5268
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 347205
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License Number State | NY
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