Provider Demographics
NPI:1851957658
Name:MIRANDA, CHAVONNE CHALENE
Entity Type:Individual
Prefix:
First Name:CHAVONNE
Middle Name:CHALENE
Last Name:MIRANDA
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 1:5448 HOFFNER AVE STE 406
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-2515
Mailing Address - Country:US
Mailing Address - Phone:407-237-0518
Mailing Address - Fax:407-237-0591
Practice Address - Street 1:5448 HOFFNER AVE STE 406
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-2515
Practice Address - Country:US
Practice Address - Phone:407-237-0518
Practice Address - Fax:407-237-0591
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL272108376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide