Basic Information
Provider Information
NPI: 1053853929
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HERSHFIELD
FirstName: CHELSEY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 15849
Address2:  
City: SAVANNAH
State: GA
PostalCode: 314162549
CountryCode: US
TelephoneNumber: 9123033560
FaxNumber: 9123033506
Practice Location
Address1: 310 EISENHOWER DR STE 16
Address2:  
City: SAVANNAH
State: GA
PostalCode: 314062632
CountryCode: US
TelephoneNumber: 9123033500
FaxNumber: 9123033509
Other Information
ProviderEnumerationDate: 11/09/2016
LastUpdateDate: 11/09/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000XRN233669 NPGAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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