Provider Demographics
NPI:1760026710
Name:LONG, CHERYL CARTER (CLO ELO ENTERPRISES)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:CARTER
Last Name:LONG
Suffix:
Gender:F
Credentials:CLO ELO ENTERPRISES
Other - Prefix:MRS
Other - First Name:CHERYL
Other - Middle Name:CARTER
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CHERYL CARTER-LONG
Mailing Address - Street 1:202 RIVER INLET RD
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-9285
Mailing Address - Country:US
Mailing Address - Phone:757-774-1547
Mailing Address - Fax:757-809-1660
Practice Address - Street 1:202 RIVER INLET RD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-9285
Practice Address - Country:US
Practice Address - Phone:757-774-1547
Practice Address - Fax:757-809-1660
Is Sole Proprietor?:No
Enumeration Date:2019-11-03
Last Update Date:2019-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver