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Individual

CHANEL TYSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
15C HEMLOCK DR APT 28, BAY SHORE, NY 11706-2923
(917) 687-4198
Mailing address
15C HEMLOCK DR APT 28, BAY SHORE, NY 11706-2923
(917) 687-4198

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
345727
NY

Other

Enumeration date
10/14/2025
Last updated
10/14/2025
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