Provider Demographics
NPI:1437835659
Name:CHERY, TRISTAN (RN)
Entity Type:Individual
Prefix:
First Name:TRISTAN
Middle Name:
Last Name:CHERY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 HILLSIDE AVE APT 2D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-2218
Mailing Address - Country:US
Mailing Address - Phone:347-513-0794
Mailing Address - Fax:
Practice Address - Street 1:10 HILLSIDE AVE APT 2D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-2218
Practice Address - Country:US
Practice Address - Phone:347-513-0794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY647847163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse