Provider Demographics
NPI:1780679274
Name:CHERIES, CATHERINE ANNE (PA)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANNE
Last Name:CHERIES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1345 36TH ST
Mailing Address - Street 2:STE B
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4811
Mailing Address - Country:US
Mailing Address - Phone:772-388-1161
Mailing Address - Fax:772-388-1470
Practice Address - Street 1:1515 US HIGHWAY 1
Practice Address - Street 2:SUITE 204
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-1612
Practice Address - Country:US
Practice Address - Phone:772-388-1161
Practice Address - Fax:772-388-1470
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2018-07-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9102091363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY6453YMedicare PIN
FLP71556Medicare UPIN