Individual
MANUEL MICHAEL CHAKNIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
2776 CLEVELAND AVE STE 602, FORT MYERS, FL 33901-5864
(239) 343-1614
(239) 343-3144
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 343-3900
(239) 343-3144
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
0810003658
VA
103T00000X
Psychologist
Primary
PY0003426
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
116060300
—
FL
Enumeration date
06/03/2006
Last updated
10/04/2023
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