Individual
CHENELLE STANFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
20900 BISCAYNE BLVD, AVENTURA, FL 33180-1407
(305) 935-1110
Mailing address
5201 AVOCADO DR, TAMARAC, FL 33319-3106
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
363A00000X
—
FL
Enumeration date
08/10/2016
Last updated
08/30/2016
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