Healthcare Provider Details

I. General information

NPI: 1144149865
Provider Name (Legal Business Name): CHELSEA BROCKWAY DDS MS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1527 S HIGHLAND AVE
CLEARWATER FL
33756-2374
US

IV. Provider business mailing address

1527 S HIGHLAND AVE
CLEARWATER FL
33756-2374
US

V. Phone/Fax

Practice location:
  • Phone: 727-250-0522
  • Fax: 727-250-0523
Mailing address:
  • Phone: 727-250-0522
  • Fax: 727-250-0523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: CHELSEA BROCKWAY
Title or Position: PRESIDENT
Credential: BROCKWAY
Phone: 727-250-0522