Provider Demographics
NPI:1154981108
Name:CHABAUD, ASHLEY H
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:H
Last Name:CHABAUD
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 1:2833 N COURSE DR APT 202
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-3091
Mailing Address - Country:US
Mailing Address - Phone:754-888-5655
Mailing Address - Fax:
Practice Address - Street 1:2740 E OAKLAND PARK BLVD STE 101
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1675
Practice Address - Country:US
Practice Address - Phone:954-491-4437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3875171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist