Healthcare Provider Details

I. General information

NPI: 1376087049
Provider Name (Legal Business Name): MRS. CHERYL IWANOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2016
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

443 TURNBERRY RD
CANTONMENT FL
32533-6818
US

IV. Provider business mailing address

443 TURNBERRY RD
CANTONMENT FL
32533-6818
US

V. Phone/Fax

Practice location:
  • Phone: 412-337-3730
  • Fax:
Mailing address:
  • Phone: 412-337-3730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA7598
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: