Provider Demographics
NPI:1235982349
Name:DAVIS, CHEYENNE LEIGH (HIGH SCHOOL DIPLOMA)
Entity Type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:LEIGH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:HIGH SCHOOL DIPLOMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464099 STATE ROAD 200
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-6459
Mailing Address - Country:US
Mailing Address - Phone:904-875-4461
Mailing Address - Fax:904-659-0130
Practice Address - Street 1:464099 STATE ROAD 200
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-6459
Practice Address - Country:US
Practice Address - Phone:904-875-4461
Practice Address - Fax:904-659-0130
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician