Provider Demographics
NPI:1124626825
Name:NERSESIAN, CHAY SHALISE (MED, ATC, LAT, CES)
Entity type:Individual
Prefix:MRS
First Name:CHAY
Middle Name:SHALISE
Last Name:NERSESIAN
Suffix:
Gender:F
Credentials:MED, ATC, LAT, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 RIVERCREST BLVD
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-2100
Mailing Address - Country:US
Mailing Address - Phone:972-727-4037
Mailing Address - Fax:972-727-7103
Practice Address - Street 1:301 RIVERCREST BLVD
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-2100
Practice Address - Country:US
Practice Address - Phone:972-727-4037
Practice Address - Fax:972-727-7103
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-14
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT2625207PS0010X, 2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine