Provider Demographics
NPI:1083154793
Name:CAVALLARO, CHELSEA ELIZABETH
Entity Type:Individual
Prefix:MRS
First Name:CHELSEA
Middle Name:ELIZABETH
Last Name:CAVALLARO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 W SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-3559
Mailing Address - Country:US
Mailing Address - Phone:516-442-7090
Mailing Address - Fax:
Practice Address - Street 1:129 W SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3559
Practice Address - Country:US
Practice Address - Phone:516-442-7090
Practice Address - Fax:516-442-7091
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-28
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020672363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant