Provider Demographics
NPI:1740712512
Name:DELA CRUZ CLIFTON, CHEERLY (CHEERLY)
Entity type:Individual
Prefix:
First Name:CHEERLY
Middle Name:
Last Name:DELA CRUZ CLIFTON
Suffix:
Gender:F
Credentials:CHEERLY
Other - Prefix:
Other - First Name:CHEERLY
Other - Middle Name:
Other - Last Name:DELA CRUZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:36743 TROPICAL WIND LANE
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32735
Mailing Address - Country:US
Mailing Address - Phone:239-687-0507
Mailing Address - Fax:
Practice Address - Street 1:36743 TROPICAL WIND LANNE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32735
Practice Address - Country:US
Practice Address - Phone:239-687-0507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-31
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA14586235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist