Provider Demographics
NPI:1093413643
Name:CANTERBURY, CHLOE DANIELLE (PA)
Entity Type:Individual
Prefix:
First Name:CHLOE
Middle Name:DANIELLE
Last Name:CANTERBURY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5408 MACALPINE CIR APT 1427
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5577
Mailing Address - Country:US
Mailing Address - Phone:810-287-5168
Mailing Address - Fax:
Practice Address - Street 1:12320 W BROAD ST
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233-7603
Practice Address - Country:US
Practice Address - Phone:804-923-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical