Provider Demographics
NPI:1386020337
Name:PERRY, CHAR'LESE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:CHAR'LESE
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 GALLERIA DR UNIT 1523
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-7099
Mailing Address - Country:US
Mailing Address - Phone:716-204-9422
Mailing Address - Fax:
Practice Address - Street 1:1 SENECA ST STE 2908
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-2734
Practice Address - Country:US
Practice Address - Phone:716-204-9422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-31
Last Update Date:2022-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY401902363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health