Provider Demographics
NPI:1801374947
Name:CHERRY, AVONDIKA S
Entity Type:Individual
Prefix:
First Name:AVONDIKA
Middle Name:S
Last Name:CHERRY
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 1:705 SELMAN RD
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:FL
Mailing Address - Zip Code:32351-8819
Mailing Address - Country:US
Mailing Address - Phone:850-445-4372
Mailing Address - Fax:
Practice Address - Street 1:705 SELMAN RD
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351-8819
Practice Address - Country:US
Practice Address - Phone:850-445-4372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management