1902261415 NPI number — SEANQUANEE DENAZIA CHANDLER HHA

Table of content: SEANQUANEE DENAZIA CHANDLER HHA (NPI 1902261415)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902261415 NPI number — SEANQUANEE DENAZIA CHANDLER HHA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHANDLER
Provider First Name:
SEANQUANEE
Provider Middle Name:
DENAZIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
HHA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902261415
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
01/11/2020
NPI Reactivation Date:
05/20/2020

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
182 PIAVE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAINES CITY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33844-7762
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-308-9192
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
182 PIAVE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAINES CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33844-7762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-934-1700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/28/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 374U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 106419200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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