Provider Demographics
NPI:1184238636
Name:DEBEJARE, CHANTELLE
Entity type:Individual
Prefix:
First Name:CHANTELLE
Middle Name:
Last Name:DEBEJARE
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 1:5591 SW 181ST CT
Mailing Address - Street 2:
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34432-2157
Mailing Address - Country:US
Mailing Address - Phone:352-456-0365
Mailing Address - Fax:352-489-0129
Practice Address - Street 1:5591 SW 181ST CT
Practice Address - Street 2:
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34432-2157
Practice Address - Country:US
Practice Address - Phone:352-456-0365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy