MEDICARE: MRS. MICHELLE ELANA CHASKES NP

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	363LP2300X	Primary Care Nurse Practitioner	SP017685	PA
2	363LP0200X	Pediatric Nurse Practitioner	F383384-01	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679929095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELLE ELANA CHASKES NP

Provider Business Mailing Address
First Line	:	410 LAKEVILLE RD STE 305
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1123
Country	:	US
Telephone Number	:	614-506-4744
Fax Number	:	215-590-3053

Provider Business Practice Location Address
First Line	:	410 LAKEVILLE RD STE 305
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1123
Country	:	US
Telephone Number	:	614-506-4744
Fax Number	:	215-590-3053

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

Provider Enumeration Date	:	05/05/2016
Last Update Date	:	06/26/2024

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