Saundra Lucinda Chisolm, NP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

F301912-1 Issued in NY

Practice address

327 Beach 19TH Street
Far Rockaway, NY 11691

Phone

(718) 869-7224

Fax

(718) 869-8226

NPI assigned

Nov 30, 2006

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

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/14448/brand/1/csg/1/fhir/r4

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.

• St John'S Medical Services PC

  • Internal Medicine Physician
  • Far Rockaway, NY
  • NPI 1023042173
  NPD

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

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1508934514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "254 PENNSYLVANIA AVE",
            "city": "FREEPORT",
            "state": "NY",
            "postal_code": "115201329",
            "telephone_number": "515-378-3224",
            "fax_number": "516-378-7181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "327 BEACH 19TH STREET",
            "city": "FAR ROCKAWAY",
            "state": "NY",
            "postal_code": "11691",
            "telephone_number": "718-869-7224",
            "fax_number": "718-869-8226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHISOLM",
        "first_name": "SAUNDRA",
        "middle_name": "LUCINDA",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F301912-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vladislav Chernyshenko, D.O.
• Martine Huguette Cherubin, R.N
• Biaux Chety, MD
• An Guo Michael Chin, DO, MPH, MS
• James Gai-Wai Chin, DO
• Tamta Chkheidze
• Mina Elizabeth Choi
• Selhee Choi, RD
• Miriam Chopp, OD
• Fatima Chowdhury, MD

• Adult Health Nurse Practitioner in Far Rockaway, NY
• Providers in Far Rockaway, NY by specialty
• Adult Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.