Healthcare Provider Details

I. General information

NPI: 1881921955
Provider Name (Legal Business Name): CHERIE BALLARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2009
Last Update Date: 11/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 NE 62ND COURT
FORT LAUDERDALE FL
33308
US

IV. Provider business mailing address

2631 EAST OAKLAND PARK BLVD. SUITE 107
FORT LAUDERDALE FL
33306
US

V. Phone/Fax

Practice location:
  • Phone: 954-892-9730
  • Fax:
Mailing address:
  • Phone: 954-563-5556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number053735-00
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: