Provider Demographics
NPI:1295536928
Name:CHANCELLOR, EBONY MARY
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:MARY
Last Name:CHANCELLOR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 LYNNFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-3441
Mailing Address - Country:US
Mailing Address - Phone:937-308-5082
Mailing Address - Fax:
Practice Address - Street 1:103 LYNNFIELD CIR
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45322-3441
Practice Address - Country:US
Practice Address - Phone:937-308-5082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker