Provider Demographics
NPI:1558555672
Name:CHADEAYNE, DIANE MARIE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:MARIE
Last Name:CHADEAYNE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 S HIGHLAND AVE
Mailing Address - Street 2:C/O ALVAREZ 2ND FLOOR
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562-5223
Mailing Address - Country:US
Mailing Address - Phone:914-582-7940
Mailing Address - Fax:
Practice Address - Street 1:65 S HIGHLAND AVE
Practice Address - Street 2:C/O ALVAREZ 2ND FLOOR
Practice Address - City:OSSINING
Practice Address - State:NY
Practice Address - Zip Code:10562-5223
Practice Address - Country:US
Practice Address - Phone:914-582-7940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY167194164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02714381Medicaid