Healthcare Provider Details

I. General information

NPI: 1104775386
Provider Name (Legal Business Name): AVERY MADISON CHADWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 CURLEY RD UNIT 206
WESLEY CHAPEL FL
33545-9156
US

IV. Provider business mailing address

7800 CURLEY RD UNIT 206
WESLEY CHAPEL FL
33545-9156
US

V. Phone/Fax

Practice location:
  • Phone: 813-467-4721
  • Fax: 813-467-4722
Mailing address:
  • Phone: 813-467-4721
  • Fax: 813-467-4722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: