Provider Demographics
NPI:1306391289
Name:CHEHAB, NADA
Entity Type:Individual
Prefix:
First Name:NADA
Middle Name:
Last Name:CHEHAB
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 1:6110 POWERS AVE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-1206
Mailing Address - Country:US
Mailing Address - Phone:904-327-7701
Mailing Address - Fax:904-508-0236
Practice Address - Street 1:6110 POWERS AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-1206
Practice Address - Country:US
Practice Address - Phone:904-327-7701
Practice Address - Fax:904-508-0236
Is Sole Proprietor?:No
Enumeration Date:2016-08-20
Last Update Date:2018-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLC100620668770172A00000X
171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter
No172A00000XOther Service ProvidersDriver