Provider Demographics
NPI:1063275345
Name:MAYES, CHAJUANA R
Entity type:Individual
Prefix:
First Name:CHAJUANA
Middle Name:R
Last Name:MAYES
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 1:13355 STATION RAIL WAY APT 430
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-2442
Mailing Address - Country:US
Mailing Address - Phone:502-509-1330
Mailing Address - Fax:
Practice Address - Street 1:13355 STATION RAIL WAY APT 430
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-2442
Practice Address - Country:US
Practice Address - Phone:502-509-1330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach