Provider Demographics
NPI:1225475817
Name:BROAD, CHERYL MAY (RN, LAC)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:MAY
Last Name:BROAD
Suffix:
Gender:F
Credentials:RN, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:407 ROLLINGSGATE CT
Mailing Address - Street 2:APT C-2
Mailing Address - City:ANDALUSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19020-7711
Mailing Address - Country:US
Mailing Address - Phone:215-300-4289
Mailing Address - Fax:
Practice Address - Street 1:407 ROLLINGSGATE CT
Practice Address - Street 2:APT C-2
Practice Address - City:ANDALUSIA
Practice Address - State:PA
Practice Address - Zip Code:19020-7711
Practice Address - Country:US
Practice Address - Phone:215-300-4289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK000487L171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist