Provider Demographics
NPI:1376300541
Name:CAVANAUGH, CHASITY DANIELLE
Entity Type:Individual
Prefix:
First Name:CHASITY
Middle Name:DANIELLE
Last Name:CAVANAUGH
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 1:3896 HECK RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PARIS
Mailing Address - State:OH
Mailing Address - Zip Code:43072-9428
Mailing Address - Country:US
Mailing Address - Phone:937-570-7475
Mailing Address - Fax:
Practice Address - Street 1:3896 HECK RD
Practice Address - Street 2:
Practice Address - City:SAINT PARIS
Practice Address - State:OH
Practice Address - Zip Code:43072-9428
Practice Address - Country:US
Practice Address - Phone:937-570-7475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No347C00000XTransportation ServicesPrivate Vehicle