Provider Demographics
NPI:1629611645
Name:WRONG, CHANDELLE MONIQUE
Entity Type:Individual
Prefix:
First Name:CHANDELLE
Middle Name:MONIQUE
Last Name:WRONG
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 1:7316 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-2011
Mailing Address - Country:US
Mailing Address - Phone:718-630-1404
Mailing Address - Fax:718-630-1406
Practice Address - Street 1:7316 13TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-2011
Practice Address - Country:US
Practice Address - Phone:718-630-1404
Practice Address - Fax:718-630-1406
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-22
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF344835-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily