Provider Demographics
NPI:1174028278
Name:CHERY, CHARITE D
Entity Type:Individual
Prefix:
First Name:CHARITE
Middle Name:D
Last Name:CHERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHARITE
Other - Middle Name:
Other - Last Name:CHERY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1928 MERRY PL APT 103
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-6322
Mailing Address - Country:US
Mailing Address - Phone:561-631-4384
Mailing Address - Fax:
Practice Address - Street 1:1928 MERRY PL APT 103
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-6322
Practice Address - Country:US
Practice Address - Phone:561-631-4384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL$$$$$$$$$Medicaid