Provider Demographics
NPI:1124862883
Name:MESA, CHAVELY
Entity type:Individual
Prefix:
First Name:CHAVELY
Middle Name:
Last Name:MESA
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 1:2500 SW 107TH AVE STE 37
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2425
Mailing Address - Country:US
Mailing Address - Phone:305-228-3780
Mailing Address - Fax:305-675-8084
Practice Address - Street 1:2500 SW 107TH AVE STE 37
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2425
Practice Address - Country:US
Practice Address - Phone:305-228-3780
Practice Address - Fax:305-675-8084
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician