Provider Demographics
NPI:1003170770
Name:HICKEY, CHERI LYN (MS)
Entity Type:Individual
Prefix:MRS
First Name:CHERI
Middle Name:LYN
Last Name:HICKEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 BOXWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-1119
Mailing Address - Country:US
Mailing Address - Phone:631-924-2915
Mailing Address - Fax:
Practice Address - Street 1:513 BOXWOOD DR
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-1119
Practice Address - Country:US
Practice Address - Phone:631-924-2915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY694756174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist