Provider Demographics
NPI:1649932278
Name:BENNETT, CHEVADREA
Entity type:Individual
Prefix:MRS
First Name:CHEVADREA
Middle Name:
Last Name:BENNETT
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 1:206 HARLEY CIR
Mailing Address - Street 2:
Mailing Address - City:CROSS
Mailing Address - State:SC
Mailing Address - Zip Code:29436-3583
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:206 HARLEY CIR
Practice Address - Street 2:
Practice Address - City:CROSS
Practice Address - State:SC
Practice Address - Zip Code:29436-3583
Practice Address - Country:US
Practice Address - Phone:843-826-5057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-11
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle