Provider Demographics
NPI:1629528021
Name:ALEXANDER, CHEVELLE L
Entity Type:Individual
Prefix:
First Name:CHEVELLE
Middle Name:L
Last Name:ALEXANDER
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 1:8015 DEGAS CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277-2892
Mailing Address - Country:US
Mailing Address - Phone:904-510-1426
Mailing Address - Fax:
Practice Address - Street 1:8015 DEGAS COURT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-3892
Practice Address - Country:US
Practice Address - Phone:904-510-1426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor