Healthcare Provider Details

I. General information

NPI: 1942548391
Provider Name (Legal Business Name): NELLE THERESA CHERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2013
Last Update Date: 01/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 FAUNCE CORNER RD STE K
NORTH DARTMOUTH MA
02747-1263
US

IV. Provider business mailing address

25 WILLIAM ST
EAST HARTFORD CT
06108-2656
US

V. Phone/Fax

Practice location:
  • Phone: 774-206-1125
  • Fax: 774-628-9657
Mailing address:
  • Phone: 216-559-2929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: