Provider Demographics
NPI:1902064587
Name:BRUDEY, CHEVELLE S (MD)
Entity Type:Individual
Prefix:DR
First Name:CHEVELLE
Middle Name:S
Last Name:BRUDEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 797182
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75379-7182
Mailing Address - Country:US
Mailing Address - Phone:214-420-9301
Mailing Address - Fax:659-903-2614
Practice Address - Street 1:14275 MIDWAY RD STE 200
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-3618
Practice Address - Country:US
Practice Address - Phone:214-420-9301
Practice Address - Fax:659-903-2614
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ06102084P0805X, 2084P0800X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine