Provider Demographics
NPI:1285193581
Name:CHAVELEH, ANDREA JOSEPHINE
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:JOSEPHINE
Last Name:CHAVELEH
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 1:17315 LAGUNA TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-7090
Mailing Address - Country:US
Mailing Address - Phone:281-687-8845
Mailing Address - Fax:
Practice Address - Street 1:10920 S RIVER FRONT PKWY
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-3538
Practice Address - Country:US
Practice Address - Phone:801-302-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-16
Last Update Date:2019-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program