MEDICARE: CHANTAY CHERIE BRANCH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225000000X	Orthotic Fitter

General Provider Information

NPI Number	:	1801516083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANTAY CHERIE BRANCH

Provider Business Mailing Address
First Line	:	14021 GRAND AVE
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-5701
Country	:	US
Telephone Number	:	952-223-0058
Fax Number	:

Provider Business Practice Location Address
First Line	:	14021 GRAND AVE
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-5701
Country	:	US
Telephone Number	:	952-223-0058
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2022
Last Update Date	:	01/23/2026

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Directions to “ CHANTAY CHERIE BRANCH ” Practice Location

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