Healthcare Provider Details

I. General information

NPI: 1326586934
Provider Name (Legal Business Name): MICHAEL JAY CHESHIRE JR. ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2017
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 208TH PL APT 3
BAYSIDE NY
11360-1139
US

IV. Provider business mailing address

1324 208TH PL APT 3
BAYSIDE NY
11360-1139
US

V. Phone/Fax

Practice location:
  • Phone: 516-242-3365
  • Fax:
Mailing address:
  • Phone: 516-242-3365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number003008-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: