Provider Demographics
NPI:1790494813
Name:DESLANDES, CHAUNDRELIA LATOYA (AGPCNP-BC)
Entity Type:Individual
Prefix:MS
First Name:CHAUNDRELIA
Middle Name:LATOYA
Last Name:DESLANDES
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 W MERCURY BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-2508
Mailing Address - Country:US
Mailing Address - Phone:757-269-9980
Mailing Address - Fax:757-330-0770
Practice Address - Street 1:49 W MERCURY BLVD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-2508
Practice Address - Country:US
Practice Address - Phone:757-269-9980
Practice Address - Fax:757-330-0770
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-17
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024185770363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health