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Individual

MATHEW VADAKKEVEETTIL CHACKO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PMHNP-BC

Contact information

Practice address
4500 S LANCASTER RD, DALLAS, TX 75216-7167
(214) 727-1031
Mailing address
306 SUNSET CT, SUNNYVALE, TX 75182-1003
(214) 727-1031

Taxonomy

Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
739088
TX
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
1089361
TX
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
57478
WY

Other

Enumeration date
12/16/2022
Last updated
12/02/2025
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