Provider Demographics
NPI:1881922482
Name:SHIMONO-LEGAULT, CHANTELLE MARIE (APRN)
Entity type:Individual
Prefix:MS
First Name:CHANTELLE
Middle Name:MARIE
Last Name:SHIMONO-LEGAULT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:CHANTELLE
Other - Middle Name:MARIE
Other - Last Name:SHIMONO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC, APRN
Mailing Address - Street 1:330 CEDAR ST
Mailing Address - Street 2:P.O. BOX 208051
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3218
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:330 CEDAR ST TMP3
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3218
Practice Address - Country:US
Practice Address - Phone:203-785-2802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4256363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily