Provider Demographics
NPI:1194841387
Name:CHERY, MARIE MYRLANDE (LPN)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:MYRLANDE
Last Name:CHERY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 STERLING RD
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-1418
Mailing Address - Country:US
Mailing Address - Phone:516-233-2371
Mailing Address - Fax:
Practice Address - Street 1:16211 96TH ST
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-4029
Practice Address - Country:US
Practice Address - Phone:718-641-3568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238680-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02663821Medicaid
NYUE05792FMedicaid