Provider Demographics
NPI:1609646868
Name:CHANEL FREEMAN NP IN PSYCHIATRY PLLC
Entity Type:Organization
Organization Name:CHANEL FREEMAN NP IN PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:MS
Authorized Official - First Name:CHANEL
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:716-544-1082
Mailing Address - Street 1:5325 SHERIDAN DR
Mailing Address - Street 2:P.O. BOX 873
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14221
Mailing Address - Country:US
Mailing Address - Phone:716-544-1082
Mailing Address - Fax:
Practice Address - Street 1:349 COTTONWOOD DR
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14221-1506
Practice Address - Country:US
Practice Address - Phone:716-544-1082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty