Provider Demographics
NPI:1841701869
Name:WEAVER, CHENELLE
Entity type:Individual
Prefix:
First Name:CHENELLE
Middle Name:
Last Name:WEAVER
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 1:8498 SE ALAMANDA WAY
Mailing Address - Street 2:
Mailing Address - City:HOBE SOUND
Mailing Address - State:FL
Mailing Address - Zip Code:33455-7104
Mailing Address - Country:US
Mailing Address - Phone:772-307-9334
Mailing Address - Fax:
Practice Address - Street 1:8498 SE ALAMANDA WAY
Practice Address - Street 2:
Practice Address - City:HOBE SOUND
Practice Address - State:FL
Practice Address - Zip Code:33455-7104
Practice Address - Country:US
Practice Address - Phone:772-307-9334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-17
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1841701869Medicaid