Chanta Mabry

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

License

BO-17-00023 Issued in NY

Practice address

1787 Fulton St
Brooklyn, NY 11233-3029

Phone

(347) 750-9089

NPI assigned

Sep 30, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1569801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569801600000",
    "number": "1285275354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 BAINBRIDGE PL UNIT 905",
            "city": "NEWBURGH",
            "state": "NY",
            "postal_code": "125507423",
            "telephone_number": "347-750-9089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1787 FULTON ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112333029",
            "telephone_number": "347-750-9089"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6 Bainbridge Pl Unit 905",
            "address_purpose": "LOCATION",
            "city": "Newburgh",
            "state": "NY",
            "postal_code": "125507423",
            "country_code": "US",
            "telephone_number": "347-750-9089",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MABRY",
        "first_name": "CHANTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-09-30",
        "last_updated": "2019-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "NY",
            "license": "BO-17-00023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Prosthetic/Orthotic Supplier in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Prosthetic/Orthotic Supplier in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.