Provider Demographics
NPI:1174846489
Name:CHAVES, AMY LYNETTE (LPN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LYNETTE
Last Name:CHAVES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 VANBUREN STREET
Mailing Address - Street 2:
Mailing Address - City:MASTIC
Mailing Address - State:NY
Mailing Address - Zip Code:11950
Mailing Address - Country:US
Mailing Address - Phone:631-664-2434
Mailing Address - Fax:
Practice Address - Street 1:158 VANBUREN STREET
Practice Address - Street 2:
Practice Address - City:MASTIC
Practice Address - State:NY
Practice Address - Zip Code:11950
Practice Address - Country:US
Practice Address - Phone:631-664-2434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271868-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse