Provider Demographics
NPI:1134492606
Name:BRABHAM, CHERYL E (MSED)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:E
Last Name:BRABHAM
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19109 120TH RD
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-3618
Mailing Address - Country:US
Mailing Address - Phone:718-949-1966
Mailing Address - Fax:718-949-1966
Practice Address - Street 1:19109 120TH RD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-3618
Practice Address - Country:US
Practice Address - Phone:718-949-1966
Practice Address - Fax:718-949-1966
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-14
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
NY584991112174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No172V00000XOther Service ProvidersCommunity Health Worker