Provider Demographics
NPI:1134870314
Name:STRAIT, CHEDVA R (FNP)
Entity type:Individual
Prefix:
First Name:CHEDVA
Middle Name:R
Last Name:STRAIT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CHEDVA
Other - Middle Name:R
Other - Last Name:GEWIRTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1809
Mailing Address - Country:US
Mailing Address - Phone:973-930-2419
Mailing Address - Fax:
Practice Address - Street 1:205 W 15TH ST APT 1B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-6413
Practice Address - Country:US
Practice Address - Phone:646-503-5202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF348979363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
2021182545OtherAMERICAN NURSES CREDENTIALING CENTER