Provider Demographics
NPI:1356102305
Name:BEAVER, CHANDRIELLE S
Entity type:Individual
Prefix:MS
First Name:CHANDRIELLE
Middle Name:S
Last Name:BEAVER
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 1:639 LINCOLN BLVD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44146-3737
Mailing Address - Country:US
Mailing Address - Phone:216-387-0420
Mailing Address - Fax:
Practice Address - Street 1:639 LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-3737
Practice Address - Country:US
Practice Address - Phone:216-387-0420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty