Provider Demographics
NPI:1073933370
Name:PATEL, CHERELLE
Entity Type:Individual
Prefix:
First Name:CHERELLE
Middle Name:
Last Name:PATEL
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 1:1809 E BROADWAY ST STE 122
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-8597
Mailing Address - Country:US
Mailing Address - Phone:407-359-5693
Mailing Address - Fax:
Practice Address - Street 1:1809 E BROADWAY ST
Practice Address - Street 2:STE 122
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-8597
Practice Address - Country:US
Practice Address - Phone:407-359-5693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst