Provider Demographics
NPI:1780626796
Name:WAYMAN, CHERYL L (PA-C)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:L
Last Name:WAYMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1001 BELLEFONTAINE AVE
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-2800
Mailing Address - Country:US
Mailing Address - Phone:419-998-4575
Mailing Address - Fax:419-998-4586
Practice Address - Street 1:602 W REDSKIN TRL
Practice Address - Street 2:
Practice Address - City:WAPAKONETA
Practice Address - State:OH
Practice Address - Zip Code:45895-9349
Practice Address - Country:US
Practice Address - Phone:419-738-5151
Practice Address - Fax:419-941-1092
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH50000778363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0460979Medicaid
OH000000664525OtherANTHEM
OHWAPA16363Medicare PIN
OH0460979Medicaid
P21711Medicare UPIN