Provider Demographics
NPI:1831439868
Name:CHAVANNES-GUSTAVE, SANDRINE (RN)
Entity type:Individual
Prefix:
First Name:SANDRINE
Middle Name:
Last Name:CHAVANNES-GUSTAVE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1558 BROOKLYN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-1931
Mailing Address - Country:US
Mailing Address - Phone:646-290-1027
Mailing Address - Fax:
Practice Address - Street 1:201 LINDEN BLVD
Practice Address - Street 2:E4
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-3498
Practice Address - Country:US
Practice Address - Phone:646-290-1027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-28
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY741630163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical