Provider Demographics
NPI:1386280394
Name:DILLON-CHAKOUR, STACY NATASHA
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:NATASHA
Last Name:DILLON-CHAKOUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8136 102ND AVE
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11416-2025
Mailing Address - Country:US
Mailing Address - Phone:718-843-3486
Mailing Address - Fax:
Practice Address - Street 1:8136 102ND AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416-2025
Practice Address - Country:US
Practice Address - Phone:718-843-3486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY731695-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health