Provider Demographics
NPI:1962778910
Name:ROMAN, CHANTEL C (RN)
Entity type:Individual
Prefix:MRS
First Name:CHANTEL
Middle Name:C
Last Name:ROMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 E 139TH ST
Mailing Address - Street 2:ROOM 100
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10454-2751
Mailing Address - Country:US
Mailing Address - Phone:718-292-4623
Mailing Address - Fax:718-292-4568
Practice Address - Street 1:383 E 139TH ST
Practice Address - Street 2:ROOM 100
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-2751
Practice Address - Country:US
Practice Address - Phone:718-292-4623
Practice Address - Fax:718-292-4568
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY594985163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool