MEDICARE: CHANELLE ELISE TIGNOR CFY-SLP

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	235Z00000X	Speech-Language Pathologist	30000153	NC

General Provider Information

NPI Number	:	1255093324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANELLE ELISE TIGNOR CFY-SLP

Provider Business Mailing Address
First Line	:	5350 PINEHURST PARK DR APT 28211
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-4915
Country	:	US
Telephone Number	:	704-684-3096
Fax Number	:

Provider Business Practice Location Address
First Line	:	307 W TREMONT AVE STE 200
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-4902
Country	:	US
Telephone Number	:	704-684-3096
Fax Number	:

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

Provider Enumeration Date	:	10/06/2021
Last Update Date	:	08/25/2022

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Directions to “ CHANELLE ELISE TIGNOR CFY-SLP” Practice Location

Language	Start Address	Practice Location

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