Provider Demographics
NPI:1326928318
Name:CHARLES, EMMANUELA (FCC)
Entity type:Individual
Prefix:
First Name:EMMANUELA
Middle Name:
Last Name:CHARLES
Suffix:
Gender:F
Credentials:FCC
Other - Prefix:
Other - First Name:ASHANTI
Other - Middle Name:SHAINA
Other - Last Name:LOUISSAINT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA IN PSYCHOLOGY
Mailing Address - Street 1:1107 W HENRY ST
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-5741
Mailing Address - Country:US
Mailing Address - Phone:857-222-6347
Mailing Address - Fax:
Practice Address - Street 1:1107 W HENRY ST
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-5741
Practice Address - Country:US
Practice Address - Phone:857-222-6347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ39-4099985Medicaid