Healthcare Provider Details

I. General information

NPI: 1366867962
Provider Name (Legal Business Name): STEPHEN CHAVEZ PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2014
Last Update Date: 02/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

2652 SOUTHERN HILLS RD
YORK PA
17403-9573
US

V. Phone/Fax

Practice location:
  • Phone: 717-515-1250
  • Fax:
Mailing address:
  • Phone: 717-515-1250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN005093
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberDI100000588
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: