Healthcare Provider Details

I. General information

NPI: 1730418757
Provider Name (Legal Business Name): ANTON ROBERT CHERRY DC, PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2009
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 GAYLORD FARM RD
WALLINGFORD CT
06492-2899
US

IV. Provider business mailing address

12 ELMWOOD RD
NEW HAVEN CT
06515-2242
US

V. Phone/Fax

Practice location:
  • Phone: 203-284-2802
  • Fax:
Mailing address:
  • Phone: 804-915-6209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1828
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number02363
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2363
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: