Provider Demographics
NPI:1427548130
Name:DEMASIADO, CHANTILLY MAE COMAHIG (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:CHANTILLY MAE
Middle Name:COMAHIG
Last Name:DEMASIADO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 MCPHERSON RD STE 330
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6417
Mailing Address - Country:US
Mailing Address - Phone:956-724-9219
Mailing Address - Fax:956-724-4120
Practice Address - Street 1:6801 MCPHERSON RD STE 330
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6417
Practice Address - Country:US
Practice Address - Phone:956-724-9219
Practice Address - Fax:956-724-4120
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137097363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner