Provider Demographics
NPI:1720886708
Name:MINIX, CHELSEA TAYLOR
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:TAYLOR
Last Name:MINIX
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 SHADY LANE RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08020-1324
Mailing Address - Country:US
Mailing Address - Phone:856-430-7695
Mailing Address - Fax:
Practice Address - Street 1:1950 ROUTE 70 E STE 201
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2128
Practice Address - Country:US
Practice Address - Phone:973-954-4592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-05
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15290200363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health