Provider Demographics
NPI:1710036090
Name:MASUD, CHERYL (PA)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:MASUD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:
Other - Last Name:POELLET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1447 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKENMUTH
Practice Address - State:MI
Practice Address - Zip Code:48734-1152
Practice Address - Country:US
Practice Address - Phone:989-652-1440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP45836Medicare UPIN
MIM74750155Medicare PIN
MI0N40360Medicare PIN