Provider Demographics
NPI:1003146945
Name:MOORE, CHERYL A (NPP)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:MOORE
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 VETERANS MEMORIAL HWY STE 5
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-4332
Mailing Address - Country:US
Mailing Address - Phone:347-743-9951
Mailing Address - Fax:855-514-2810
Practice Address - Street 1:356 VETERANS MEMORIAL HWY STE 5
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-4332
Practice Address - Country:US
Practice Address - Phone:347-743-9951
Practice Address - Fax:855-514-2810
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-26
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400097163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health