Provider Demographics
NPI:1801407101
Name:CHISOLM, NIKELIA
Entity Type:Individual
Prefix:MS
First Name:NIKELIA
Middle Name:
Last Name:CHISOLM
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 1:211H W 151ST ST APT 2A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10039-1965
Mailing Address - Country:US
Mailing Address - Phone:917-536-6306
Mailing Address - Fax:
Practice Address - Street 1:515 CENTERPOINT DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-7570
Practice Address - Country:US
Practice Address - Phone:860-438-8950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program