MEDICARE: MS. MALDALENA PATRICE CHAVIS CRNP

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	363LF0000X	Family Nurse Practitioner	SP012415	PA
2	363LF0000X	Family Nurse Practitioner	APN.29822.APRN	SC
3	363LF0000X	Family Nurse Practitioner	APRN11039599	FL
4	363LF0000X	Family Nurse Practitioner	0024193620	VA
5	363LF0000X	Family Nurse Practitioner	14266	CT
6	363LF0000X	Family Nurse Practitioner	26NJ15356500	NJ

General Provider Information

NPI Number	:	1487905014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MALDALENA PATRICE CHAVIS CRNP

Provider Business Mailing Address
First Line	:	3637 OLD YORK RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-4229
Country	:	US
Telephone Number	:	215-787-7441
Fax Number	:

Provider Business Practice Location Address
First Line	:	161 CECIL B MOORE AVE APT 204
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19122-3243
Country	:	US
Telephone Number	:	866-306-2026
Fax Number	:

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

Provider Enumeration Date	:	09/22/2012
Last Update Date	:	01/15/2026

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