Individual
ELLYSSA BRADY CHINNASWAMY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4940 EASTERN AVE, BALTIMORE, MD 21224-2735
(508) 954-0741
Mailing address
749 EAGLE POINT DR, VENICE, FL 34285-5000
(508) 954-0741
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
COOO7434
MD
Other
Enumeration date
12/20/2019
Last updated
12/20/2019
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