Provider Demographics
NPI:1912323817
Name:STADT, CHELSEA (LPN)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:STADT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:RYEN
Other - Last Name:STADT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:24 BROXBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-1720
Mailing Address - Country:US
Mailing Address - Phone:585-410-2779
Mailing Address - Fax:
Practice Address - Street 1:24 BROXBOURNE DR
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-1720
Practice Address - Country:US
Practice Address - Phone:585-410-2779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-16
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303898164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse