Provider Demographics
NPI:1376784116
Name:BENNETT, CHERYL
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 SOUTH ST
Mailing Address - Street 2:APT. 3D
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-7413
Mailing Address - Country:US
Mailing Address - Phone:845-667-4181
Mailing Address - Fax:
Practice Address - Street 1:830 SOUTH ST
Practice Address - Street 2:APT. 3D
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-7413
Practice Address - Country:US
Practice Address - Phone:845-667-4181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204158164W00000X
NY201458164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse