Provider Demographics
NPI:1477614170
Name:EDWARDS, CHERYL Y (MD)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:Y
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 CONCORD TER
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2815
Mailing Address - Country:US
Mailing Address - Phone:800-243-3839
Mailing Address - Fax:844-550-8801
Practice Address - Street 1:550 W HWY 50
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-2238
Practice Address - Country:US
Practice Address - Phone:719-530-2048
Practice Address - Fax:719-530-2055
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301081097174400000X
NV12986207V00000X
CAG70752207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICE081097OtherBCBS LICENSE
MICE081097OtherBCBS LICENSE
MI0E27609028Medicare ID - Type Unspecified
MI104482347Medicare ID - Type Unspecified
NVBU047ZMedicare PIN