Provider Demographics
NPI:1659394450
Name:PEREIRA, CHERYL (ANP)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:PEREIRA
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 FRENCH RD STE 103
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-1044
Mailing Address - Country:US
Mailing Address - Phone:315-735-3541
Mailing Address - Fax:315-724-3255
Practice Address - Street 1:555 FRENCH RD STE 103
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-1044
Practice Address - Country:US
Practice Address - Phone:315-735-3541
Practice Address - Fax:315-724-3255
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3011551363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
4125995OtherMVP
NYRA3056Medicare PIN
NYQ22060Medicare UPIN