Provider Demographics
NPI:1447445580
Name:CATO, CHELLISE (MD)
Entity type:Individual
Prefix:
First Name:CHELLISE
Middle Name:
Last Name:CATO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S PINE ISLAND RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3920
Mailing Address - Country:US
Mailing Address - Phone:772-336-2818
Mailing Address - Fax:772-336-5313
Practice Address - Street 1:1850 SW FOUNTAINVIEW BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-3443
Practice Address - Country:US
Practice Address - Phone:772-336-2818
Practice Address - Fax:772-336-5313
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96420208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL279427600Medicaid