Healthcare Provider Details

I. General information

NPI: 1114604345
Provider Name (Legal Business Name): JEEDA CHEWEIKY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2023
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12900 EASTLAKE BLVD STE 111
EL PASO TX
79928-7874
US

IV. Provider business mailing address

1210 CELESTE CT
SUGAR LAND TX
77479-5439
US

V. Phone/Fax

Practice location:
  • Phone: 915-213-0332
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number41751
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: