Provider Demographics
NPI:1154661528
Name:CHERYL WASKIEWICZ APRN LLC
Entity Type:Organization
Organization Name:CHERYL WASKIEWICZ APRN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:WASKIEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:203-988-7895
Mailing Address - Street 1:131 ENGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-2434
Mailing Address - Country:US
Mailing Address - Phone:203-988-7895
Mailing Address - Fax:
Practice Address - Street 1:131 ENGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-2434
Practice Address - Country:US
Practice Address - Phone:203-988-7895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-22
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001617364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, AdultGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT500001255Medicare PIN
CTQ12533Medicare UPIN