MEDICARE: CHERYL L SANFACON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MD022288E	PA

General Provider Information

NPI Number	:	1548362478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL L SANFACON M.D.

Provider Business Mailing Address
First Line	:	111 PRESIDENTIAL BLVD
Second Line	:	SUITE 220
City	:	BALA CYNWYD
State	:	PA
Zip	:	19004-1008
Country	:	US
Telephone Number	:	610-667-8960
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 PRESIDENTIAL BLVD
Second Line	:	SUITE 220
City	:	BALA CYNWYD
State	:	PA
Zip	:	19004-1008
Country	:	US
Telephone Number	:	610-667-8960
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	07/08/2007

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