Healthcare Provider Details

I. General information

NPI: 1114044146
Provider Name (Legal Business Name): CHAD DOUGLAS SCHELLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 JOHNSON ST DEPT OF
HOLLYWOOD FL
33021
US

IV. Provider business mailing address

1117 E HALLANDALE BEACH BLVD
HALLANDALE BEACH FL
33009-4488
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-6301
  • Fax: 954-985-1434
Mailing address:
  • Phone: 954-454-5131
  • Fax: 954-241-6908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberME129467
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberME-129-467
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: