Provider Demographics
NPI:1700222841
Name:MORENO, CHERRYL ARROYO (MT)
Entity Type:Individual
Prefix:
First Name:CHERRYL
Middle Name:ARROYO
Last Name:MORENO
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:CHERRYL
Other - Middle Name:CAPANAS
Other - Last Name:ARROYO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MT
Mailing Address - Street 1:2267 SEATTLE SLEW DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234-7663
Mailing Address - Country:US
Mailing Address - Phone:317-946-5848
Mailing Address - Fax:317-736-4321
Practice Address - Street 1:231 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-7310
Practice Address - Country:US
Practice Address - Phone:317-946-5848
Practice Address - Fax:317-736-4321
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010784246QM0706X
246RP1900X, 247ZC0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician