Healthcare Provider Details

I. General information

NPI: 1629626452
Provider Name (Legal Business Name): CHERYLITA RICHARDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2019
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 N POINT BLVD STE 227
BALTIMORE MD
21224-3470
US

IV. Provider business mailing address

1107 N POINT BLVD STE 227
BALTIMORE MD
21224-3470
US

V. Phone/Fax

Practice location:
  • Phone: 410-213-5154
  • Fax: 410-779-3794
Mailing address:
  • Phone: 410-213-5154
  • Fax: 410-779-3794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberA00008526
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: