Healthcare Provider Details

I. General information

NPI: 1760576268
Provider Name (Legal Business Name): CHERRY CHEVY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 10/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 BROWNING PL SUITE 201
RALEIGH NC
27609-6508
US

IV. Provider business mailing address

3900 BROWNING PL STE 201
RALEIGH NC
27609-6530
US

V. Phone/Fax

Practice location:
  • Phone: 919-270-1071
  • Fax: 919-781-9952
Mailing address:
  • Phone: 919-787-7125
  • Fax: 919-781-9952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number99-00185
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number99-00185
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: