Provider Demographics
NPI:1508088667
Name:CHITAYAT, CHERYL S (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:S
Last Name:CHITAYAT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:358 VETERANS MEMORIAL HWY.
Mailing Address - Street 2:SUITE 12
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-4332
Mailing Address - Country:US
Mailing Address - Phone:631-864-5535
Mailing Address - Fax:
Practice Address - Street 1:358 VETERANS MEMORIAL HWY.
Practice Address - Street 2:SUITE 12
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-4332
Practice Address - Country:US
Practice Address - Phone:631-864-5535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009723103T00000X, 103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS09723-8OtherWCB#
NYS09723-8OtherWCB#