Provider Demographics
NPI:1205230182
Name:CHERY, CASSANDRA (LPN)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
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 1:31 EAGLE ST
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:10977-6102
Mailing Address - Country:US
Mailing Address - Phone:845-538-5726
Mailing Address - Fax:
Practice Address - Street 1:31 EAGLE ST
Practice Address - Street 2:
Practice Address - City:CHESTNUT RIDGE
Practice Address - State:NY
Practice Address - Zip Code:10977-6102
Practice Address - Country:US
Practice Address - Phone:845-538-5726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY318569-1164W00000X
NJ26NP07167800164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse