Provider Demographics
NPI:1508420506
Name:DAZZELL, CHERRY A
Entity Type:Individual
Prefix:
First Name:CHERRY
Middle Name:A
Last Name:DAZZELL
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 1:215 E 10TH ST BSMT
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-7630
Mailing Address - Country:US
Mailing Address - Phone:929-346-9232
Mailing Address - Fax:
Practice Address - Street 1:3175 E TREMONT AVE FL 2
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-5700
Practice Address - Country:US
Practice Address - Phone:718-239-8239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator