Provider Demographics
NPI:1053655464
Name:CHANEY, ANDREW H (PA-C)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:H
Last Name:CHANEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4332 CORTEZ RD W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-3139
Mailing Address - Country:US
Mailing Address - Phone:941-462-2004
Mailing Address - Fax:
Practice Address - Street 1:4332 CORTEZ RD W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-3139
Practice Address - Country:US
Practice Address - Phone:941-462-2004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-26
Last Update Date:2022-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians