Provider Demographics
NPI:1518060920
Name:CRESTA, CHERYL ANN (EDM,CTRS)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:CRESTA
Suffix:
Gender:F
Credentials:EDM,CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 BOSTON POST RD # 152
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-2043
Mailing Address - Country:US
Mailing Address - Phone:203-931-4070
Mailing Address - Fax:203-931-4068
Practice Address - Street 1:114 BOSTON POST RD
Practice Address - Street 2:# 152
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-2043
Practice Address - Country:US
Practice Address - Phone:203-931-4070
Practice Address - Fax:203-931-4068
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist