Provider Demographics
NPI:1013440452
Name:CHAVANNES, NASTACIA (MD)
Entity Type:Individual
Prefix:
First Name:NASTACIA
Middle Name:
Last Name:CHAVANNES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 S MAIN ST UNIT 345
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-5032
Mailing Address - Country:US
Mailing Address - Phone:954-860-0857
Mailing Address - Fax:
Practice Address - Street 1:JERSEY SHORE UNIVERSITY MEDICAL CENTER
Practice Address - Street 2:1943 ROUTE 33
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753
Practice Address - Country:US
Practice Address - Phone:732-755-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2959252084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry