Provider Demographics
NPI:1740951391
Name:CHANEY, TONYA SOPHIA (LAC)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:SOPHIA
Last Name:CHANEY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 BUCKNER RD
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-7166
Mailing Address - Country:US
Mailing Address - Phone:813-480-0933
Mailing Address - Fax:
Practice Address - Street 1:3040 E COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-5220
Practice Address - Country:US
Practice Address - Phone:813-331-3940
Practice Address - Fax:813-331-3941
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP4095171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1871992545OtherNPI OF ORGANIZATION OF HIRE