Individual
CHANTEL BRIANA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1339 WASHINGTON AVE, BAY SHORE, NY 11706-5742
(631) 356-8488
Mailing address
1339 WASHINGTON AVE, BAY SHORE, NY 11706-5742
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
354567
NY
Other
Enumeration date
10/04/2025
Last updated
10/04/2025
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