Provider Demographics
NPI:1003146945
Name:MOORE, CHERYL A (NPP)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:MOORE
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5036 JERICHO TPKE STE 203
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2812
Mailing Address - Country:US
Mailing Address - Phone:631-486-8118
Mailing Address - Fax:631-462-5258
Practice Address - Street 1:5036 JERICHO TPKE STE 203
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2812
Practice Address - Country:US
Practice Address - Phone:631-486-8118
Practice Address - Fax:631-462-5258
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-26
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400097163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health