Provider Demographics
NPI:1508934514
Name:CHISOLM, SAUNDRA LUCINDA (NP)
Entity Type:Individual
Prefix:MRS
First Name:SAUNDRA
Middle Name:LUCINDA
Last Name:CHISOLM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:254 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-1329
Mailing Address - Country:US
Mailing Address - Phone:515-378-3224
Mailing Address - Fax:516-378-7181
Practice Address - Street 1:327 BEACH 19TH STREET
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691
Practice Address - Country:US
Practice Address - Phone:718-869-7224
Practice Address - Fax:718-869-8226
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF301912-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health