Provider Demographics
NPI:1245299098
Name:WHYTE, AUTHRINE CHEVANNE (MD PHD)
Entity type:Individual
Prefix:
First Name:AUTHRINE
Middle Name:CHEVANNE
Last Name:WHYTE
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 ADMIRALTY BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-5201
Mailing Address - Country:US
Mailing Address - Phone:321-305-6968
Mailing Address - Fax:321-305-6941
Practice Address - Street 1:1209 ADMIRALTY BLVD
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-5201
Practice Address - Country:US
Practice Address - Phone:321-305-6968
Practice Address - Fax:321-305-6941
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90434207Q00000X
FLME90864207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3964664OtherCIGNA
FL1326256OtherAETNA
FL28799OtherBLUE CROSS BLUE SHIELD
FL275441000Medicaid
FLU5052ZMedicare ID - Type Unspecified
FL1326256OtherAETNA
FLI34132Medicare UPIN