Provider Demographics
NPI:1306504238
Name:CHEVRY, CHANTAL CHERUBIN
Entity type:Individual
Prefix:
First Name:CHANTAL
Middle Name:CHERUBIN
Last Name:CHEVRY
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 1:1126 ANCHOR ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-1115
Mailing Address - Country:US
Mailing Address - Phone:267-401-6471
Mailing Address - Fax:
Practice Address - Street 1:7157 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19135-1008
Practice Address - Country:US
Practice Address - Phone:267-701-0816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA62333601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health