Provider Demographics
NPI:1255648051
Name:SARTAIN, CHERYL ANN (PMHNP)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:SARTAIN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1768 BUSINESS CENTER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5359
Mailing Address - Country:US
Mailing Address - Phone:800-762-9244
Mailing Address - Fax:786-672-6006
Practice Address - Street 1:1768 BUSINESS CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5359
Practice Address - Country:US
Practice Address - Phone:800-762-9244
Practice Address - Fax:786-672-6006
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR26473363LP0808X
TX868542163WP0808X
TXAP127119363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND054517Medicaid
ND84029Medicaid
ND84029Medicaid
NDN715741Medicare PIN