Individual provider · Type 1 NPI

Chantel Briana Wallace, LPN

Licensed Practical Nurse · Bay Shore, NY

NPI number 1750255394 Active

Practice location

1339 Washington Ave
Bay Shore, NY 11706-5742

Call (631) 356-8488 Map

Specialties and licenses

TaxonomyCodeLicense
Licensed Practical Nurse Primary 164W00000X354567 (NY)

Licensed Practical Nurse: An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.

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About NPI 1750255394

Chantel Briana Wallace, LPN's National Provider Identifier is 1750255394, issued on Oct 4, 2025. The primary taxonomy on file is Licensed Practical Nurse (164W00000X), and the practice location is in Bay Shore, NY. The record was last updated on Oct 4, 2025.