Provider Demographics
NPI:1144795667
Name:CHERRY, BRIANNA SHUREE
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:SHUREE
Last Name:CHERRY
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 1:133 DELSEA DR
Mailing Address - Street 2:
Mailing Address - City:WESTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08093-1160
Mailing Address - Country:US
Mailing Address - Phone:302-563-8188
Mailing Address - Fax:
Practice Address - Street 1:937 E HAVERFORD RD STE 101
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3800
Practice Address - Country:US
Practice Address - Phone:610-520-2490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG012522225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist