MEDICARE: MS. CHERRISSE BUNCH NP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	404435	NY
2	363LA2200X	Adult Health Nurse Practitioner	F305789-1	NY

General Provider Information

NPI Number	:	1568742781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHERRISSE BUNCH NP

Provider Business Mailing Address
First Line	:	2079 FOREST AVE UNIT 30073
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10303-1767
Country	:	US
Telephone Number	:	929-855-6289
Fax Number	:	718-691-7735

Provider Business Practice Location Address
First Line	:	2079 FOREST AVE UNIT 30073
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10303-1767
Country	:	US
Telephone Number	:	929-855-6289
Fax Number	:	718-691-7735

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

Provider Enumeration Date	:	08/18/2011
Last Update Date	:	03/08/2026

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