Provider Demographics
NPI:1053661074
Name:SAHATEVASUKONT, CHITCHAWAL (NP)
Entity Type:Individual
Prefix:MR
First Name:CHITCHAWAL
Middle Name:
Last Name:SAHATEVASUKONT
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 VARIATIONS DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-1009
Mailing Address - Country:US
Mailing Address - Phone:770-363-0793
Mailing Address - Fax:
Practice Address - Street 1:22722 29TH DR SE
Practice Address - Street 2:STE 100
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-4420
Practice Address - Country:US
Practice Address - Phone:770-363-0793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2020-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4663363LP0808X
IAG136472363LP0808X
GARN176776363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health