Provider Demographics
NPI:1558121335
Name:PARDE, CHATWAROT THANASIRIKULSAK
Entity Type:Individual
Prefix:MRS
First Name:CHATWAROT
Middle Name:THANASIRIKULSAK
Last Name:PARDE
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 1:1334 BUTTERNUT ST APT 1
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13208-2944
Mailing Address - Country:US
Mailing Address - Phone:814-933-6989
Mailing Address - Fax:
Practice Address - Street 1:1334 BUTTERNUT ST APT 1
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13208-2944
Practice Address - Country:US
Practice Address - Phone:814-933-6989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY825003163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse