Provider Demographics
NPI:1336706357
Name:CHAPPELLE, SHINITA MARIE
Entity Type:Individual
Prefix:
First Name:SHINITA
Middle Name:MARIE
Last Name:CHAPPELLE
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 1:219 BRUNSWICK BLVD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14208-1632
Mailing Address - Country:US
Mailing Address - Phone:716-935-8344
Mailing Address - Fax:
Practice Address - Street 1:219 BRUNSWICK BLVD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14208-1632
Practice Address - Country:US
Practice Address - Phone:716-935-8344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY548463-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY906347078OtherNEW YORK STATE DRIVER LICENSE