Provider Demographics
NPI:1134871684
Name:VILLASENOR, CHEERY (APRN)
Entity type:Individual
Prefix:
First Name:CHEERY
Middle Name:
Last Name:VILLASENOR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 FOXWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-2506
Mailing Address - Country:US
Mailing Address - Phone:914-424-6164
Mailing Address - Fax:
Practice Address - Street 1:24 FOXWOOD RD
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-2506
Practice Address - Country:US
Practice Address - Phone:914-424-6164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10265363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily