Provider Demographics
NPI:1245205566
Name:ANDERSON, CHERONNE DANETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHERONNE
Middle Name:DANETTE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7425 MAGIC VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-5417
Mailing Address - Country:US
Mailing Address - Phone:801-205-6486
Mailing Address - Fax:
Practice Address - Street 1:12595 S MINUTEMAN DR
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9541
Practice Address - Country:US
Practice Address - Phone:801-882-2618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT18570512052084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTBA3069956OtherDEA
UTBA3069956OtherDEA