Individual provider Active NPI

Miranda Chakos

  • Psychiatry Physician
  • Suffolk, VA
National Provider Identifier
1093775744
Registry record updated Mar 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
0101053901 Issued in VA
Practice address
5131 River Club Dr Ste 200
Suffolk, VA 23435-3837
Phone
(804) 207-6737
NPI assigned
Mar 26, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 0101053901 VA Primary

Addresses

Primary practice location

5131 River Club Dr Ste 200
Suffolk, VA 23435-3837

Mailing address

104 Knight St
Oceanside, NY 11572-4611
Phone (718) 270-1748

Other identifiers 1

IdentifierTypeStateIssuer
20H872MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221102002096 VA Practitioner - Psychiatry 3375438146 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Commonwealth Counseling Associates IncGroup PAC ID 0941288583, 207 clinicians

Practice addresses (Care Compare)

5131 River Club Dr
Suite 200
Suffolk, VA 23435-3837
Phone (804) 207-6737

9202 Ctr Oak CT
Mechanicsville, VA 23116-2744
Phone (804) 207-6737

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
0101053901VAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Commonwealth Counseling Associates Inc Psychiatry CurrentSince Sep 20, 2022 Accepting new patients
University Physicians of Brooklyn Psychiatry Past Accepting new patients
Downstate Mental Hygiene Associates Past Accepting new patients

Locations

9202 Center Oak Ct
Mechanicsvlle, VA 23116
Phone (804) 639-1112

5131 River Club Dr
Ste 200
Suffolk, VA 23435
Phone (757) 792-9756

Interoperability endpoints

  • Direct secure messaging: lifestancehealth.mirandachakos@134000.advancedmd-direct.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742342400000",
    "number": "1093775744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 KNIGHT ST",
            "city": "OCEANSIDE",
            "state": "NY",
            "postal_code": "115724611",
            "telephone_number": "718-270-1748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5131 RIVER CLUB DR STE 200",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234353837",
            "telephone_number": "804-207-6737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAKOS",
        "first_name": "MIRANDA",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-26",
        "last_updated": "2025-03-19",
        "certification_date": "2025-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "VA",
            "license": "0101053901",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20H872",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Suffolk, VA

Sources for this page

Verify at the official NPI Registry.