Provider Demographics
NPI:1649513474
Name:CHANCELLOR, BREEHAN KELLEY (MD)
Entity type:Individual
Prefix:DR
First Name:BREEHAN
Middle Name:KELLEY
Last Name:CHANCELLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BREEHAN
Other - Middle Name:ROSE
Other - Last Name:KELLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1200 E RIDGEWOOD AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3937
Mailing Address - Country:US
Mailing Address - Phone:201-327-8600
Mailing Address - Fax:
Practice Address - Street 1:1200 E RIDGEWOOD AVE STE 200
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3937
Practice Address - Country:US
Practice Address - Phone:201-327-8600
Practice Address - Fax:201-327-8225
Is Sole Proprietor?:No
Enumeration Date:2013-03-29
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA108544002084N0400X, 2084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology