Provider Demographics
NPI:1982042065
Name:CHAND, SHANTI KUMARI
Entity Type:Individual
Prefix:
First Name:SHANTI
Middle Name:KUMARI
Last Name:CHAND
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 1:27 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-8214
Mailing Address - Country:US
Mailing Address - Phone:631-741-6275
Mailing Address - Fax:
Practice Address - Street 1:49 CREST ST
Practice Address - Street 2:OAK HOLLOW NURSING CENTER
Practice Address - City:MIDDLE ISLAND
Practice Address - State:NY
Practice Address - Zip Code:11953
Practice Address - Country:US
Practice Address - Phone:631-924-8820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3101501164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse