Provider Demographics
NPI:1871809319
Name:CHANG, ANNETTE MELANIE
Entity type:Individual
Prefix:MS
First Name:ANNETTE
Middle Name:MELANIE
Last Name:CHANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6948 NW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-4308
Mailing Address - Country:US
Mailing Address - Phone:929-200-0627
Mailing Address - Fax:
Practice Address - Street 1:13735 134TH AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11436-2144
Practice Address - Country:US
Practice Address - Phone:954-646-9269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301286-1164W00000X
FLPN5166573164W00000X
NY749803163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse