Provider Demographics
NPI:1992384143
Name:NELSON, CAMERON MITCHELL (ATC)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:MITCHELL
Last Name:NELSON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 ANGELI ARCH
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-6989
Mailing Address - Country:US
Mailing Address - Phone:757-377-4786
Mailing Address - Fax:
Practice Address - Street 1:1100 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-5670
Practice Address - Country:US
Practice Address - Phone:757-377-4786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program