Provider Demographics
NPI:1639604002
Name:CHERESTAL-EDOUARD, FARAH (LPN)
Entity Type:Individual
Prefix:MRS
First Name:FARAH
Middle Name:
Last Name:CHERESTAL-EDOUARD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 KIRKBY RD
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-3544
Mailing Address - Country:US
Mailing Address - Phone:516-710-0506
Mailing Address - Fax:
Practice Address - Street 1:5353 MERRICK RD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-6209
Practice Address - Country:US
Practice Address - Phone:516-798-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY316893-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse