Provider Demographics
NPI:1497451256
Name:EKHATOR, CHAVANNIE
Entity Type:Individual
Prefix:
First Name:CHAVANNIE
Middle Name:
Last Name:EKHATOR
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 1:2258 WARWICK RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-3714
Mailing Address - Country:US
Mailing Address - Phone:321-615-2177
Mailing Address - Fax:
Practice Address - Street 1:2258 WARWICK RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-3714
Practice Address - Country:US
Practice Address - Phone:321-615-2177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health