Provider Demographics
NPI:1699398248
Name:CHAKRAVERTY, LAFLEUR THERESA (NP)
Entity Type:Individual
Prefix:MS
First Name:LAFLEUR
Middle Name:THERESA
Last Name:CHAKRAVERTY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 94TH ST
Mailing Address - Street 2:
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11369-1138
Mailing Address - Country:US
Mailing Address - Phone:347-210-1583
Mailing Address - Fax:
Practice Address - Street 1:2345 94TH ST
Practice Address - Street 2:
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11369-1138
Practice Address - Country:US
Practice Address - Phone:347-210-1583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF402780-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health