Provider Demographics
NPI:1093731531
Name:CHEUNG, SHERI D (MD)
Entity Type:Individual
Prefix:
First Name:SHERI
Middle Name:D
Last Name:CHEUNG
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 1:58 OLD NORTH RD
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01098-9753
Mailing Address - Country:US
Mailing Address - Phone:413-238-5511
Mailing Address - Fax:413-238-5358
Practice Address - Street 1:73 RUSSELL RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:MA
Practice Address - Zip Code:01050-9777
Practice Address - Country:US
Practice Address - Phone:413-667-3009
Practice Address - Fax:413-667-3009
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207021207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0120537Medicaid
MAJ22975OtherBLUE CROSS BLUE SHIELD MA
MA409873OtherTUFTS HEALTH PLAN
MA26870OtherHEALTH NEW ENGLAND
MAJ22975OtherBLUE CROSS BLUE SHIELD MA
MAA31362Medicare ID - Type Unspecified