Provider Demographics
NPI:1518390079
Name:BREWER-JADYKIN, CHERYL A (RN)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:BREWER-JADYKIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BLACKPINE DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-4102
Mailing Address - Country:US
Mailing Address - Phone:631-207-9137
Mailing Address - Fax:
Practice Address - Street 1:17 BLACKPINE DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-4102
Practice Address - Country:US
Practice Address - Phone:631-207-9137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY674878163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse