Provider Demographics
NPI:1467047142
Name:JOHNSON, CHERYL DANIELLE
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:DANIELLE
Last Name:JOHNSON
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 1:1037 LAUREL RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32773-7429
Mailing Address - Country:US
Mailing Address - Phone:407-600-8765
Mailing Address - Fax:
Practice Address - Street 1:1037 LAUREL RIDGE LN
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773-7429
Practice Address - Country:US
Practice Address - Phone:407-600-8765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health