Provider Demographics
NPI:1407067556
Name:CHEVILLET, JULIE NICOLE (DO)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:NICOLE
Last Name:CHEVILLET
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11406
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4005
Mailing Address - Country:US
Mailing Address - Phone:321-637-2705
Mailing Address - Fax:321-255-6929
Practice Address - Street 1:7970 N WICKHAM RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-8299
Practice Address - Country:US
Practice Address - Phone:321-637-2705
Practice Address - Fax:321-255-6929
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 10966207X00000X, 207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002497900Medicaid
FL002497900Medicaid