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Individual

DR. CHANTAL ALYSE VAN WELY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
11825 SW GREENBURG RD STE 206, TIGARD, OR 97223-6466
(503) 395-4626
(503) 386-3294
Mailing address
201 14TH ST SW, LARGO, FL 33770-3133

Taxonomy

Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
MD223876
OR
2084P0800X
Psychiatry Physician
Primary
ME158562
FL

Other

Enumeration date
05/21/2021
Last updated
08/26/2025
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