Provider Demographics
NPI:1659484079
Name:GOLDSTEIN, CHERI LYNNE (PA-C)
Entity Type:Individual
Prefix:
First Name:CHERI
Middle Name:LYNNE
Last Name:GOLDSTEIN
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 1:5939 HARRY HINES BLVD
Mailing Address - Street 2:POB II, HQ8.827C
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-9258
Mailing Address - Country:US
Mailing Address - Phone:214-645-1949
Mailing Address - Fax:
Practice Address - Street 1:5909 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-0001
Practice Address - Country:US
Practice Address - Phone:214-645-1949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00123363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS59408Medicare UPIN
TXTXB128353Medicare PIN