Provider Demographics
NPI:1396855201
Name:CHANEY, OLIVIA A (MD)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:A
Last Name:CHANEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S WOODLAND ST
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3546
Mailing Address - Country:US
Mailing Address - Phone:407-905-8827
Mailing Address - Fax:407-886-3822
Practice Address - Street 1:618 S FOREST AVE
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-5338
Practice Address - Country:US
Practice Address - Phone:407-886-6201
Practice Address - Fax:407-886-3822
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME30549208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL037415600Medicaid
FLU8529ZMedicare ID - Type UnspecifiedAPOPKA-WINTER GARDEN
FL037415600Medicaid