Provider Demographics
NPI:1619860293
Name:CHALKLETT, CHANTIA MICHELLE
Entity type:Individual
Prefix:
First Name:CHANTIA
Middle Name:MICHELLE
Last Name:CHALKLETT
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 1:18309 MICHAEL AVE
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-6859
Mailing Address - Country:US
Mailing Address - Phone:216-417-9480
Mailing Address - Fax:
Practice Address - Street 1:18309 MICHAEL AVE
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-6859
Practice Address - Country:US
Practice Address - Phone:216-417-9480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker