Provider Demographics
NPI:1518785419
Name:GABELUS, CHANNEDIEULINE
Entity type:Individual
Prefix:
First Name:CHANNEDIEULINE
Middle Name:
Last Name:GABELUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4204 6TH ST W
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-1218
Mailing Address - Country:US
Mailing Address - Phone:239-851-5397
Mailing Address - Fax:
Practice Address - Street 1:4204 6TH ST W
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-1218
Practice Address - Country:US
Practice Address - Phone:239-851-5397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities