Healthcare Provider Details

I. General information

NPI: 1700801578
Provider Name (Legal Business Name): CHERRY ANN WY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHERRY ANN WY M.D.

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1144 COFFEE RD
MODESTO CA
95355-4205
US

IV. Provider business mailing address

PO BOX 255228
SACRAMENTO CA
95865-5228
US

V. Phone/Fax

Practice location:
  • Phone: 209-524-1211
  • Fax:
Mailing address:
  • Phone: 191-670-8803
  • Fax: 855-202-9336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberA70518
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA70518
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: