Provider Demographics
NPI:1598534893
Name:CHANTILOUPE, DENNEILLE KAYLA
Entity Type:Individual
Prefix:
First Name:DENNEILLE
Middle Name:KAYLA
Last Name:CHANTILOUPE
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 1:11011 SHERIDAN ST STE 210
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33026-1531
Mailing Address - Country:US
Mailing Address - Phone:954-552-6668
Mailing Address - Fax:954-206-5584
Practice Address - Street 1:1925 BIRKDALE DR
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-5809
Practice Address - Country:US
Practice Address - Phone:954-906-7002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-27
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician