Provider Demographics
NPI:1245779800
Name:BYRON, CHAD
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:BYRON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4660 HARWICH ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-2715
Mailing Address - Country:US
Mailing Address - Phone:321-960-8701
Mailing Address - Fax:
Practice Address - Street 1:4660 HARWICH ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-2715
Practice Address - Country:US
Practice Address - Phone:321-960-8701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician