Provider Demographics
NPI:1649897950
Name:MCDONALD, CHERYL ROSEMARIE (CNC)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:ROSEMARIE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:CNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 KITTBUCK WAY
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-5700
Mailing Address - Country:US
Mailing Address - Phone:631-384-5010
Mailing Address - Fax:
Practice Address - Street 1:2560 KITTBUCK WAY
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-5700
Practice Address - Country:US
Practice Address - Phone:631-384-5010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PN1OtherPERSONAL PAYMENT