Provider Demographics
NPI:1487036091
Name:CHERY, WALLYNE THOMAS
Entity Type:Individual
Prefix:MISS
First Name:WALLYNE
Middle Name:THOMAS
Last Name:CHERY
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 1:285 NE 117TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-6101
Mailing Address - Country:US
Mailing Address - Phone:239-867-7085
Mailing Address - Fax:
Practice Address - Street 1:285 NE 117TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-6101
Practice Address - Country:US
Practice Address - Phone:239-867-7085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-19
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17069225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics