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General NPI Number Information
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NPI Number | 1639863285
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Entity Type | Individual
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Provider Name | CHANTELLE THANDEKA WHITE MD
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Gender | Female
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Dates
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Enumeration Date | 06/06/2023
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Last Update Date | 06/06/2023
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Provider Practice Location Address
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Address Line | 1005 JOE DIMAGGIO DR
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City | HOLLYWOOD
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State | FL
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Zip | 33021-5487
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Country | US
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Telephone | 954-265-5324
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Fax |
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Provider Business Mailing Address
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Address Line | 10366 E CLAIRMONT CIR
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City | TAMARAC
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State | FL
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Zip | 33321-7835
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Country | US
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Telephone | 954-347-3900
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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