Provider Demographics
NPI:1063233484
Name:EDWARDS, CHANTELL D
Entity type:Individual
Prefix:
First Name:CHANTELL
Middle Name:D
Last Name:EDWARDS
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 1:2582 CENTERGATE DR APT 207
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-0712
Mailing Address - Country:US
Mailing Address - Phone:305-609-9187
Mailing Address - Fax:
Practice Address - Street 1:2582 CENTERGATE DR APT 207
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-0712
Practice Address - Country:US
Practice Address - Phone:305-609-9187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician