Provider Demographics
NPI:1083147219
Name:BICEGLIA, CHANON C (DNP, PMHNP-BC, NP-C)
Entity Type:Individual
Prefix:DR
First Name:CHANON
Middle Name:C
Last Name:BICEGLIA
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 69724
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-0021
Mailing Address - Country:US
Mailing Address - Phone:203-816-5551
Mailing Address - Fax:
Practice Address - Street 1:555 HIGHLAND AVE STE 27
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2255
Practice Address - Country:US
Practice Address - Phone:203-816-5551
Practice Address - Fax:203-816-5551
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-05
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ242355363LA2200X, 363LP0808X
CT12.006985363LA2200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health