Provider Demographics
NPI:1043625411
Name:CHERRY, LARRY JR
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:
Last Name:CHERRY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2948 ANTIQUE OAKS CIR
Mailing Address - Street 2:UNIT 92
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-5656
Mailing Address - Country:US
Mailing Address - Phone:407-205-7310
Mailing Address - Fax:
Practice Address - Street 1:1434 MARVIN C ZANDERS AVE
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-7070
Practice Address - Country:US
Practice Address - Phone:407-485-3484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator