MEDICARE: DEVON CHECHIK NTP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133NN1002X	Nutrition Education Nutritionist

General Provider Information

NPI Number	:	1225759335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEVON CHECHIK NTP

Provider Business Mailing Address
First Line	:	1313 HILLSIDE AVE
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23322-4610
Country	:	US
Telephone Number	:	805-540-4420
Fax Number	:

Provider Business Practice Location Address
First Line	:	1313 HILLSIDE AVE
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23322-4610
Country	:	US
Telephone Number	:	805-540-4420
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2022
Last Update Date	:	09/07/2022

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