Provider Demographics
NPI:1417931882
Name:CHERRY, PATRICIA (LDN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:CHERRY
Suffix:
Gender:F
Credentials:LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 MIDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-5255
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:660 SUMMIT CROSSING PL
Practice Address - Street 2:SUITE #306
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2104
Practice Address - Country:US
Practice Address - Phone:704-671-7830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL000742133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5040770OtherUNITED HEALTHCARE
NC312280OtherFEDERAL BLACK LUNG
NC00207OtherBLUE CROSS
NC0067840OtherAETNA
NC0590625010OtherCIGNA
NC3697OtherWELLPATH
NC460595Medicaid
NC3400032Medicaid
NC340032Medicare ID - Type UnspecifiedMEDICARE
NC235048Medicare ID - Type UnspecifiedCIGNA MEDICARE