Provider Demographics
NPI:1093737504
Name:ROSENTHAL, CHERYL A (APRN)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:ROSENTHAL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-2791
Mailing Address - Country:US
Mailing Address - Phone:203-270-7592
Mailing Address - Fax:
Practice Address - Street 1:54 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-2358
Practice Address - Country:US
Practice Address - Phone:203-270-7592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002614363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT31660OtherCT CONTROLLED SUBSTANCE
CTMR0771370OtherFEDERAL DEA
CT500000769Medicare ID - Type Unspecified
CT31660OtherCT CONTROLLED SUBSTANCE