Provider Demographics
NPI:1225582430
Name:CHISI, SIBONGILE
Entity Type:Individual
Prefix:MS
First Name:SIBONGILE
Middle Name:
Last Name:CHISI
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 1:58 HARTFELD DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-1708
Mailing Address - Country:US
Mailing Address - Phone:585-766-3053
Mailing Address - Fax:
Practice Address - Street 1:1800 ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-5202
Practice Address - Country:US
Practice Address - Phone:718-299-4764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-05
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020700225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist