Provider Demographics
NPI:1700699865
Name:CHESTNUT, BRAINCA SHANTA
Entity type:Individual
Prefix:MISS
First Name:BRAINCA
Middle Name:SHANTA
Last Name:CHESTNUT
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:BRAINCA
Other - Middle Name:SHANTA
Other - Last Name:CHESTNUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 FAIRWAY DR FL FAIRWAY
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-1814
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:120 E LUZON DR
Practice Address - Street 2:
Practice Address - City:FORT LIBERTY
Practice Address - State:NC
Practice Address - Zip Code:28307-6012
Practice Address - Country:US
Practice Address - Phone:229-726-8738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician