Provider Demographics
NPI:1710554852
Name:CHANDALLY, ADEE (LMT)
Entity Type:Individual
Prefix:
First Name:ADEE
Middle Name:
Last Name:CHANDALLY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 CORNELIA ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-6002
Mailing Address - Country:US
Mailing Address - Phone:917-566-3415
Mailing Address - Fax:
Practice Address - Street 1:32 UNION SQ E STE 612N
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3243
Practice Address - Country:US
Practice Address - Phone:917-740-0737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032086225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist