Provider Demographics
NPI:1598734949
Name:WORRELL, CHERYL B (DMD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:B
Last Name:WORRELL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 WILLOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10302-2221
Mailing Address - Country:US
Mailing Address - Phone:718-448-0266
Mailing Address - Fax:718-448-3491
Practice Address - Street 1:35 WILLOWBROOK RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10302-2221
Practice Address - Country:US
Practice Address - Phone:718-448-0266
Practice Address - Fax:718-448-3491
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0408441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01066908Medicaid