Healthcare Provider Details

I. General information

NPI: 1316432370
Provider Name (Legal Business Name): CHEYENNE LA'SHAY MANUEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2018
Last Update Date: 06/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 25TH ST
WEST PALM BEACH FL
33407-5411
US

IV. Provider business mailing address

1782 ABBEY RD APT 201E
WEST PALM BEACH FL
33415-5655
US

V. Phone/Fax

Practice location:
  • Phone: 561-203-0040
  • Fax:
Mailing address:
  • Phone: 561-631-7782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: