Provider Demographics
NPI:1104044551
Name:BOSTON, CHERYL (AUD, FAAA)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:BOSTON
Suffix:
Gender:F
Credentials:AUD, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9308 SAFFRON HILL CT
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-7947
Mailing Address - Country:US
Mailing Address - Phone:703-330-6636
Mailing Address - Fax:703-330-1058
Practice Address - Street 1:8644 SUDLEY RD
Practice Address - Street 2:SUITE 114
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4417
Practice Address - Country:US
Practice Address - Phone:703-330-3363
Practice Address - Fax:703-330-1058
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201000358231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist