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Individual

MINI CHACKO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
140 OLD ORANGEBURG RD, ORANGEBURG, NY 10962-1157
(845) 680-5704
Mailing address
140 OLD ORANGEBURG RD, ORANGEBURG, NY 10962-1157
(845) 680-5704

Taxonomy

Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
593186-01
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
F403410-01
NY

Other

Enumeration date
06/04/2024
Last updated
06/04/2024
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