Provider Demographics
NPI:1346576030
Name:SCHNEIDER, CHERYL LYNN (RDH)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:LYNN
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:LYNN
Other - Last Name:SHORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:400 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-5022
Mailing Address - Country:US
Mailing Address - Phone:262-893-5105
Mailing Address - Fax:
Practice Address - Street 1:400 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-5022
Practice Address - Country:US
Practice Address - Phone:262-893-5105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-30
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2761124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1346576030Medicaid