Provider Demographics
NPI:1609934140
Name:CURTIS, CHERYL L (PA -C)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:L
Last Name:CURTIS
Suffix:
Gender:F
Credentials:PA -C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:110 FRANCIS ST STE 2A
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5501
Mailing Address - Country:US
Mailing Address - Phone:617-632-8383
Mailing Address - Fax:
Practice Address - Street 1:330 BROOKLINE AVE # SHAPIRO7
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5400
Practice Address - Country:US
Practice Address - Phone:617-667-8800
Practice Address - Fax:949-650-1274
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2022-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18172363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA330204983 0048OtherCIGNA GROUP NUMBER
CAPA17172OtherCA LICENSE
CA330204983OtherTAX ID
CA330204983 0039OtherCIGNA GROUP NUMBER
CAYYY49979YOtherBLUE SHIELD
CA0000000135OtherGNP GROUP NUMBER
CA019023OtherGNP
CA1750339479OtherNPI GROUP NUMBER
CAGR002729Medicaid