Provider Demographics
NPI:1578933537
Name:PERSAUD, CHRIS (R N)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:PERSAUD
Suffix:
Gender:M
Credentials:R N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12703 97TH AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11419-1503
Mailing Address - Country:US
Mailing Address - Phone:347-420-4101
Mailing Address - Fax:718-849-2379
Practice Address - Street 1:12703 97TH AVE
Practice Address - Street 2:
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-1503
Practice Address - Country:US
Practice Address - Phone:347-420-4101
Practice Address - Fax:718-849-2379
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-03
Last Update Date:2015-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY699144-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse