Provider Demographics
NPI:1356501399
Name:PHILOCHE, CHESLYE (MA)
Entity Type:Individual
Prefix:
First Name:CHESLYE
Middle Name:
Last Name:PHILOCHE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2174 HARRIS AVE NE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-4040
Mailing Address - Country:US
Mailing Address - Phone:321-574-5719
Mailing Address - Fax:321-952-0697
Practice Address - Street 1:2174 HARRIS AVE NE
Practice Address - Street 2:SUITE 3
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-4040
Practice Address - Country:US
Practice Address - Phone:321-574-5719
Practice Address - Fax:321-952-0697
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 30179171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor