Provider Demographics
NPI:1609800085
Name:CHANDLER, CHERYL A (PA-C)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 WASHINGTON ST
Mailing Address - Street 2:SUITE 2220
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-2491
Mailing Address - Country:US
Mailing Address - Phone:508-823-5104
Mailing Address - Fax:508-880-7870
Practice Address - Street 1:72 WASHINGTON ST
Practice Address - Street 2:SUITE 2220
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-2491
Practice Address - Country:US
Practice Address - Phone:508-823-5104
Practice Address - Fax:508-880-7870
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1988363AM0700X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q51385Medicare UPIN
MAAP2479Medicare PIN