Healthcare Provider Details

I. General information

NPI: 1891726980
Provider Name (Legal Business Name): CHERYL LYN MURRAY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHERYL LYN HEINTZELMAN PA-C

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 BIRDSEYE RD
FARMINGTON CT
06032-2444
US

IV. Provider business mailing address

130 BIRDSEYE RD
FARMINGTON CT
06032-2444
US

V. Phone/Fax

Practice location:
  • Phone: 860-840-7300
  • Fax: 860-840-7300
Mailing address:
  • Phone: 860-840-7300
  • Fax: 860-840-7300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001866
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: