Provider Demographics
NPI:1639318447
Name:KENDALL, CHANELLE (MEDICAL ASSISTANT)
Entity Type:Individual
Prefix:
First Name:CHANELLE
Middle Name:
Last Name:KENDALL
Suffix:
Gender:F
Credentials:MEDICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:682 UNION AVE
Mailing Address - Street 2:NEW CASSEL COMMUNITY HEALTH CENTER
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590
Mailing Address - Country:US
Mailing Address - Phone:516-571-9500
Mailing Address - Fax:516-572-5793
Practice Address - Street 1:682 UNION AVE
Practice Address - Street 2:NEW CASSEL COMMUNITY HEALTH CENTER
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590
Practice Address - Country:US
Practice Address - Phone:516-571-9500
Practice Address - Fax:516-572-5793
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
07978OtherHOSPITAL ID#