Provider Demographics
NPI:1609542182
Name:KELLEY, CHERYCE TOSHAY
Entity Type:Individual
Prefix:
First Name:CHERYCE
Middle Name:TOSHAY
Last Name:KELLEY
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 1:2430 MEREDITH DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-1423
Mailing Address - Country:US
Mailing Address - Phone:147-016-7346
Mailing Address - Fax:614-732-0586
Practice Address - Street 1:2430 MEREDITH DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-1423
Practice Address - Country:US
Practice Address - Phone:147-016-7346
Practice Address - Fax:614-732-0586
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide