=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326829094
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHEVELLE BRUDEY MD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2023
-----------------------------------------------------
Last Update Date | 05/21/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14275 MIDWAY RD STE 200
-----------------------------------------------------
City | ADDISON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75001-3618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-420-9301
-----------------------------------------------------
Fax | 659-903-2614
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 797182
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75379-7182
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-420-9301
-----------------------------------------------------
Fax | 659-903-2614
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHIATRIST
-----------------------------------------------------
Name | DR. CHEVELLE BRUDEY
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 888-806-1928
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------