Provider Demographics
NPI:1548786627
Name:MERRILL, CHOTSANI
Entity Type:Individual
Prefix:
First Name:CHOTSANI
Middle Name:
Last Name:MERRILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHOTSANI
Other - Middle Name:
Other - Last Name:AYALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:781 DAVENPORT ST SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-6556
Mailing Address - Country:US
Mailing Address - Phone:321-987-0515
Mailing Address - Fax:
Practice Address - Street 1:781 DAVENPORT ST SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909
Practice Address - Country:US
Practice Address - Phone:321-987-0515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL240820374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL240820OtherCNA