Provider Demographics
NPI:1790101137
Name:CHISHTI, CHERRY ANN MONTEHERMOSO (MED)
Entity Type:Individual
Prefix:
First Name:CHERRY ANN
Middle Name:MONTEHERMOSO
Last Name:CHISHTI
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:CHERRY ANN
Other - Middle Name:ORBE
Other - Last Name:MONTEHERMOSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10659 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-1541
Mailing Address - Country:US
Mailing Address - Phone:347-552-4549
Mailing Address - Fax:
Practice Address - Street 1:10659 95TH ST
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11417-1541
Practice Address - Country:US
Practice Address - Phone:347-552-4549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-10
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
NY1410267103K00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst