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NPI Code Detail

MEDICARE: CHELSEY LYNNE EVANGELISTE BA

MEDICARE: CHELSEY LYNNE EVANGELISTE BA
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
1103K00000XBehavior Analyst1-26-88367GA

General Provider Information

NPI Number : 1629682521
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHELSEY LYNNE EVANGELISTE BA
Provider Business Mailing Address
First Line : 130 CORRIDOR RD UNIT 3292
Second Line :
City : PONTE VEDRA BEACH
State : FL
Zip : 32004-7833
Country : US
Telephone Number : 904-446-0953
Fax Number : 904-485-8829
Provider Business Practice Location Address
First Line : 1709 BUNKER HILL RD
Second Line :
City : COLUMBUS
State : GA
Zip : 31907-6719
Country : US
Telephone Number : 904-446-0953
Fax Number : 904-485-8829
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2020
Last Update Date : 05/06/2026

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