Individual
MR. CHANEL UPSHUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
11736 NASHVILLE BLVD, CAMBRIA HEIGHTS, NY 11411-1537
(646) 372-0195
Mailing address
11736 NASHVILLE BLVD, CAMBRIA HEIGHTS, NY 11411-1537
(646) 372-0195
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
286511-14
NY
Other
Enumeration date
01/10/2007
Last updated
07/08/2007
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