Provider Demographics
NPI:1295774891
Name:EBY, CHERISH DIVINA (PA-C)
Entity type:Individual
Prefix:
First Name:CHERISH
Middle Name:DIVINA
Last Name:EBY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 5TH AVENUE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-217-4217
Practice Address - Street 1:12 ST PAUL DR STE 207
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1035
Practice Address - Country:US
Practice Address - Phone:717-217-6882
Practice Address - Fax:717-217-6883
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA003067L363AM0700X, 363AS0400X
MDC0002427363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103150701Medicaid
PA867633OtherMEDICARE GROUP #
PA25-1716306OtherINTERGROUP
PAMA003067LOtherLICENSE
PA50089803OtherCAPITAL BLUECROSS
PA25-1716306OtherHEALTHNET/TRICARE
PA25-1716306OtherHEALTHNET/TRICARE
MD073M913EMedicare ID - Type Unspecified
PAME0756847OtherDEA
PA25-1716306OtherINTERGROUP
MDP39125Medicare UPIN