Provider Demographics
NPI:1336689462
Name:CHAVOUS, IDALIA
Entity Type:Individual
Prefix:
First Name:IDALIA
Middle Name:
Last Name:CHAVOUS
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 1:173 AVENUE B APT 3A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-4656
Mailing Address - Country:US
Mailing Address - Phone:646-770-4820
Mailing Address - Fax:
Practice Address - Street 1:173 AVENUE B APT 3A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-4656
Practice Address - Country:US
Practice Address - Phone:646-770-4820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health