Provider Demographics
NPI:1083983555
Name:CHAVA, CINDY L (PA)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:L
Last Name:CHAVA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:L
Other - Last Name:PUCKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1514 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2483
Mailing Address - Country:US
Mailing Address - Phone:504-842-4023
Mailing Address - Fax:
Practice Address - Street 1:1514 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70121-2429
Practice Address - Country:US
Practice Address - Phone:504-842-4023
Practice Address - Fax:504-842-0094
Is Sole Proprietor?:No
Enumeration Date:2011-12-29
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015398363A00000X
LAPA.200619363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant