Healthcare Provider Details

I. General information

NPI: 1346194644
Provider Name (Legal Business Name): CHERYL MARIE RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2026
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 MAPLE ST STE 306
SPRINGFIELD MA
01105-1828
US

IV. Provider business mailing address

155 MAPLE ST STE 306
SPRINGFIELD MA
01105-1828
US

V. Phone/Fax

Practice location:
  • Phone: 617-661-3991
  • Fax:
Mailing address:
  • Phone: 617-661-3991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: