Healthcare Provider Details

I. General information

NPI: 1780186247
Provider Name (Legal Business Name): ASHANI CHERRY PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2018
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 CAMPUS DRIVE
COLLEGE PARK MD
20742-0001
US

IV. Provider business mailing address

140 CAMPUS DRIVE
COLLEGE PARK MD
20742-0001
US

V. Phone/Fax

Practice location:
  • Phone: 301-314-8190
  • Fax:
Mailing address:
  • Phone: 301-314-8190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110-006102
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: