Provider Demographics
NPI:1225219207
Name:GRAHAM, CHERYL ANN (REGISTERED NURSE)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:ANN
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 LENOX AVE
Mailing Address - Street 2:APT 7E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-3003
Mailing Address - Country:US
Mailing Address - Phone:718-804-0900
Mailing Address - Fax:718-735-6382
Practice Address - Street 1:803 STERLING PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-3903
Practice Address - Country:US
Practice Address - Phone:718-804-0900
Practice Address - Fax:718-735-6382
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-19
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY432618-1163WA2000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No251S00000XAgenciesCommunity/Behavioral Health