MEDICARE: DR. CHANTEL DYLANDE AMARILLO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	310299	NY

General Provider Information

NPI Number	:	1063919199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHANTEL DYLANDE AMARILLO MD

Provider Business Mailing Address
First Line	:	1280 DEKALB AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-3204
Country	:	US
Telephone Number	:	718-455-9000
Fax Number	:	718-452-6112

Provider Business Practice Location Address
First Line	:	1280 DEKALB AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-3204
Country	:	US
Telephone Number	:	718-455-9000
Fax Number	:	718-452-6112

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2018
Last Update Date	:	08/03/2021

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