Provider Demographics
NPI:1376368563
Name:MABEREY, CHANTELLE SHADRINA
Entity type:Individual
Prefix:
First Name:CHANTELLE
Middle Name:SHADRINA
Last Name:MABEREY
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 1:744 EMPIRE ST STE 120
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-5550
Mailing Address - Country:US
Mailing Address - Phone:707-440-9923
Mailing Address - Fax:
Practice Address - Street 1:744 EMPIRE ST STE 120
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-5550
Practice Address - Country:US
Practice Address - Phone:707-440-9923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist