Provider Demographics
NPI:1295226249
Name:ADABA, CHANTELLE BRIELLE YOUNG (MD, MS)
Entity type:Individual
Prefix:DR
First Name:CHANTELLE
Middle Name:BRIELLE YOUNG
Last Name:ADABA
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:DR
Other - First Name:CHANTELLE
Other - Middle Name:BRIELLE
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:MAYPORT NAVAL BASE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32228
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:848 CANDLEBARK DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-5322
Practice Address - Country:US
Practice Address - Phone:404-934-0077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-25
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program