Provider Demographics
NPI:1699549998
Name:GILLARD, CHANTELLE (CD-L)
Entity type:Individual
Prefix:
First Name:CHANTELLE
Middle Name:
Last Name:GILLARD
Suffix:
Gender:F
Credentials:CD-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 MELROSE AVE # 1
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13206-3471
Mailing Address - Country:US
Mailing Address - Phone:315-863-7601
Mailing Address - Fax:
Practice Address - Street 1:104 MELROSE AVE # 1
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13206-3471
Practice Address - Country:US
Practice Address - Phone:315-863-7601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula