Healthcare Provider Details

I. General information

NPI: 1477301943
Provider Name (Legal Business Name): CHEYENNE SIERRA SCHENK DNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2024
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 ASHTON OAKS DR
SAINT AUGUSTINE FL
32092-0830
US

IV. Provider business mailing address

141 ASHTON OAKS DR
SAINT AUGUSTINE FL
32092-0830
US

V. Phone/Fax

Practice location:
  • Phone: 561-644-2025
  • Fax:
Mailing address:
  • Phone: 561-644-2025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11032589
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: