Provider Demographics
NPI:1982745493
Name:HEIDELBERGER, CHERYL (MD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:HEIDELBERGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10733 MIRASOL DR APT 311
Mailing Address - Street 2:
Mailing Address - City:MIROMAR LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33913-7790
Mailing Address - Country:US
Mailing Address - Phone:928-203-0525
Mailing Address - Fax:
Practice Address - Street 1:10733 MIRASOL DR APT 311
Practice Address - Street 2:
Practice Address - City:MIROMAR LAKES
Practice Address - State:FL
Practice Address - Zip Code:33913-7790
Practice Address - Country:US
Practice Address - Phone:928-203-0525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251422084P0800X, 2084P0804X
TXG94742084P0800X, 2084P0804X
IL036-0642882084P0800X, 2084P0804X
FLME 1102262084P0800X, 2084P0804X, 2084P0804X
MDD00793862084P0800X, 2084P0804X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015493000Medicaid
AZ413881OtherAHCCCS
AZP087G4676Medicaid
FL015493000Medicaid
AZP087G4676Medicaid