Healthcare Provider Details

I. General information

NPI: 1255321402
Provider Name (Legal Business Name): CHERYL S CERUTTI CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: CHERYL S DANISHEVSKY CRNA

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12303 DELPAUL DRIVE
BRIDGETON MO
63044
US

IV. Provider business mailing address

12303 DELPAUL DRIVE
BRIDGETON MO
63044
US

V. Phone/Fax

Practice location:
  • Phone: 314-344-7049
  • Fax: 314-344-7073
Mailing address:
  • Phone: 314-344-7049
  • Fax: 314-344-7073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN067117
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number067117
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: