Provider Demographics
NPI:1932857752
Name:CLOUD, CHEYANNE L I
Entity Type:Individual
Prefix:
First Name:CHEYANNE
Middle Name:L
Last Name:CLOUD
Suffix:I
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 1:3527 TRAIL RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-3366
Mailing Address - Country:US
Mailing Address - Phone:904-330-6984
Mailing Address - Fax:
Practice Address - Street 1:782 FOXRIDGE CENTER DR
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-5776
Practice Address - Country:US
Practice Address - Phone:904-637-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-206746106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician