Provider Demographics
NPI:1376854422
Name:BEACH, CHEYENNE MACNARY (MD)
Entity Type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:MACNARY
Last Name:BEACH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 PARK STREET
Mailing Address - Street 2:YALE NEW HAVEN HOSPITAL WP2
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510
Mailing Address - Country:US
Mailing Address - Phone:203-785-4081
Mailing Address - Fax:203-737-7635
Practice Address - Street 1:1 PARK STREET
Practice Address - Street 2:YALE NEW HAVEN HOSPITAL WP2
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510
Practice Address - Country:US
Practice Address - Phone:203-785-4081
Practice Address - Fax:203-737-7635
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2017-04-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMT197577208000000X
MI4301108945208000000X, 2080P0202X
CT56318208000000X, 2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics