Provider Demographics
NPI:1710712880
Name:RAY, CHANTEL NEDKESHIA
Entity type:Individual
Prefix:
First Name:CHANTEL
Middle Name:NEDKESHIA
Last Name:RAY
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 1:703 W PLAZA PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-1229
Mailing Address - Country:US
Mailing Address - Phone:813-317-1252
Mailing Address - Fax:
Practice Address - Street 1:703 W PLAZA PL
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-1229
Practice Address - Country:US
Practice Address - Phone:813-317-1252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant