Provider Demographics
NPI:1508456682
Name:ANTENOR, ASHANTE CHALCEDONY (CCMA, CET)
Entity Type:Individual
Prefix:
First Name:ASHANTE
Middle Name:CHALCEDONY
Last Name:ANTENOR
Suffix:
Gender:F
Credentials:CCMA, CET
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1973 BRANDYWINE RD APT 107
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-6803
Mailing Address - Country:US
Mailing Address - Phone:954-289-7247
Mailing Address - Fax:
Practice Address - Street 1:1973 BRANDYWINE RD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-6802
Practice Address - Country:US
Practice Address - Phone:954-289-7247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
FLK3K8Y3P3251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health