Provider Demographics
NPI:1083998991
Name:JAMISON, CHERI
Entity Type:Individual
Prefix:
First Name:CHERI
Middle Name:
Last Name:JAMISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 W 123RD ST
Mailing Address - Street 2:APT G.
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-5443
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:587 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10044-0096
Practice Address - Country:US
Practice Address - Phone:212-223-5055
Practice Address - Fax:212-223-5031
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY791895971156F00000X
NY765253971174400000X
NY763541971174400000X
NY274705031235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist
No174400000XOther Service ProvidersSpecialist
No235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist