Provider Demographics
NPI:1376578880
Name:WASKIEWICZ, CHERYL (APRN)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:WASKIEWICZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 ENGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-2434
Mailing Address - Country:US
Mailing Address - Phone:203-799-8180
Mailing Address - Fax:209-179-9818
Practice Address - Street 1:131 ENGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-2434
Practice Address - Country:US
Practice Address - Phone:203-799-8180
Practice Address - Fax:209-179-9818
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001617363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT500001255Medicare ID - Type Unspecified
CTQ12533Medicare UPIN