Provider Demographics
NPI:1306659156
Name:GORDON, CHYENNE
Entity type:Individual
Prefix:
First Name:CHYENNE
Middle Name:
Last Name:GORDON
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 1:2256 HIGHWAY 78
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:SC
Mailing Address - Zip Code:29437-3905
Mailing Address - Country:US
Mailing Address - Phone:843-513-0234
Mailing Address - Fax:
Practice Address - Street 1:2256 HIGHWAY 78
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:SC
Practice Address - Zip Code:29437-3905
Practice Address - Country:US
Practice Address - Phone:843-513-0234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care