Provider Demographics
NPI:1720715634
Name:NISSINOFF, CHELSEA ARIEL (OD)
Entity Type:Individual
Prefix:DR
First Name:CHELSEA
Middle Name:ARIEL
Last Name:NISSINOFF
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:CHELSEA
Other - Middle Name:ARIEL
Other - Last Name:BRAFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:278 WEATHERED EDGE DR
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-7656
Mailing Address - Country:US
Mailing Address - Phone:607-283-1182
Mailing Address - Fax:
Practice Address - Street 1:161 HAMPTON POINT DR STE 3
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-3058
Practice Address - Country:US
Practice Address - Phone:904-287-9137
Practice Address - Fax:904-287-9057
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC6167152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist