Provider Demographics
NPI:1154113637
Name:BROCKINGTON, CHANTAL SANTASHA
Entity type:Individual
Prefix:
First Name:CHANTAL
Middle Name:SANTASHA
Last Name:BROCKINGTON
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 1:3140 CRICKET RD
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19605-2130
Mailing Address - Country:US
Mailing Address - Phone:610-905-6217
Mailing Address - Fax:
Practice Address - Street 1:3140 CRICKET RD
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19605-2130
Practice Address - Country:US
Practice Address - Phone:610-905-6217
Practice Address - Fax:610-905-6217
Is Sole Proprietor?:No
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program