Healthcare Provider Details

I. General information

NPI: 1154950301
Provider Name (Legal Business Name): CHAUNTELLE NAOMI HAYES ELLIS CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10801 LOCKWOOD DR STE 230
SILVER SPRING MD
20901-1559
US

IV. Provider business mailing address

12211 PLUM ORCHARD DR STE 220
SILVER SPRING MD
20904-7919
US

V. Phone/Fax

Practice location:
  • Phone: 301-593-5566
  • Fax:
Mailing address:
  • Phone: 301-754-3060
  • Fax: 301-681-0789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR218545
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR218545
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN1040262
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: