Provider Demographics
NPI:1356383558
Name:WRAY, CHERYL ANN (MA)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:WRAY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:CHERYLE
Other - Middle Name:ANN
Other - Last Name:ANDRESEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:860 OMNI BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4430
Mailing Address - Country:US
Mailing Address - Phone:757-232-8769
Mailing Address - Fax:757-232-8875
Practice Address - Street 1:5818 HARBOUR VIEW BLVD STE 230D
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3315
Practice Address - Country:US
Practice Address - Phone:757-673-6118
Practice Address - Fax:757-967-9003
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2101 001409237600000X
VA2201001176231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA013013L76Medicare PIN