Provider Demographics
NPI:1891078655
Name:CHACKO, SUNINA MONCY (NP-C)
Entity Type:Individual
Prefix:
First Name:SUNINA
Middle Name:MONCY
Last Name:CHACKO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6721 N. LE MAI
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712
Mailing Address - Country:US
Mailing Address - Phone:847-401-1670
Mailing Address - Fax:
Practice Address - Street 1:6721 N LE MAI AVE
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-3103
Practice Address - Country:US
Practice Address - Phone:847-401-1670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008936363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health