Provider Demographics
NPI:1609006501
Name:REISER, CHERYL
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:REISER
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 1:3408 S ATLANTIC AVE # 1052
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:32118-6311
Mailing Address - Country:US
Mailing Address - Phone:386-767-3719
Mailing Address - Fax:386-767-4319
Practice Address - Street 1:3408 S ATLANTIC AVE # 1052
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH SHORES
Practice Address - State:FL
Practice Address - Zip Code:32118-6311
Practice Address - Country:US
Practice Address - Phone:386-767-3719
Practice Address - Fax:386-767-4319
Is Sole Proprietor?:No
Enumeration Date:2009-07-26
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL03-31-2000103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst