Healthcare Provider Details

I. General information

NPI: 1972169779
Provider Name (Legal Business Name): CHANIQUE TREVIA JAMES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2019
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date: 01/13/2020
Reactivation Date: 12/23/2024

III. Provider practice location address

2801 N STATE ROAD 7
MARGATE FL
33063-5727
US

IV. Provider business mailing address

1016 NW 130TH TER
SUNRISE FL
33323-3907
US

V. Phone/Fax

Practice location:
  • Phone: 954-974-0400
  • Fax:
Mailing address:
  • Phone: 786-665-5304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number157190
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: