Provider Demographics
NPI:1245406545
Name:CONWELL, CHERYL ANN (ANP)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:ANN
Last Name:CONWELL
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:MRS
Other - First Name:CHERYL
Other - Middle Name:
Other - Last Name:COOTELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP
Mailing Address - Street 1:535 EAST 70TH STREET
Mailing Address - Street 2:
Mailing Address - City:NY
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:212-606-1223
Mailing Address - Fax:212-774-2227
Practice Address - Street 1:535 EAST 70TH STREET
Practice Address - Street 2:
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-606-1223
Practice Address - Fax:212-774-2227
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3021911363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP95377Medicare UPIN