Healthcare Provider Details

I. General information

NPI: 1265210348
Provider Name (Legal Business Name): MICHELLE CHAFFARDET
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 HIGHLAND ST
COCOA FL
32922-7523
US

IV. Provider business mailing address

126 HIGHLAND ST
COCOA FL
32922-7523
US

V. Phone/Fax

Practice location:
  • Phone: 305-970-5519
  • Fax: 305-970-5519
Mailing address:
  • Phone: 305-970-5519
  • Fax: 305-970-5519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberMT4716
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT4716
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMT4716
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberMT4716
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberMT4716
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberMT4716
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: