Provider Demographics
NPI:1760868764
Name:FUGATE-FOWLER, CHERI
Entity Type:Individual
Prefix:
First Name:CHERI
Middle Name:
Last Name:FUGATE-FOWLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 VILLAGE GREEN PKWY
Mailing Address - Street 2:STE 16
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-3404
Mailing Address - Country:US
Mailing Address - Phone:941-795-2811
Mailing Address - Fax:941-795-4889
Practice Address - Street 1:600 FAIRWAY DR
Practice Address - Street 2:SUITE 100
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-1811
Practice Address - Country:US
Practice Address - Phone:954-354-3738
Practice Address - Fax:954-354-0171
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS2512237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist