Provider Demographics
NPI:1932276920
Name:PERCY-SEIDE, CHANTAL (NP)
Entity Type:Individual
Prefix:MRS
First Name:CHANTAL
Middle Name:
Last Name:PERCY-SEIDE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:982 WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510
Mailing Address - Country:US
Mailing Address - Phone:516-632-5632
Mailing Address - Fax:516-417-8560
Practice Address - Street 1:10261 66TH ROAD
Practice Address - Street 2:NORTH SHORE HOSPITAL
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:718-830-4316
Practice Address - Fax:718-830-1158
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304462363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health