Provider Demographics
NPI:1982214946
Name:CHANDLER, JAMEL VONTARIUS
Entity Type:Individual
Prefix:MR
First Name:JAMEL
Middle Name:VONTARIUS
Last Name:CHANDLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JAMEL
Other - Middle Name:V
Other - Last Name:CHANDLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2665 MISSION ROAD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32304
Mailing Address - Country:US
Mailing Address - Phone:850-544-3748
Mailing Address - Fax:
Practice Address - Street 1:2665 MISSION ROAD.
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32304
Practice Address - Country:US
Practice Address - Phone:850-544-3748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-05
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker