Healthcare Provider Details

I. General information

NPI: 1003146945
Provider Name (Legal Business Name): CHERYL A MOORE NPP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2009
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

356 VETERANS MEMORIAL HWY STE 5
COMMACK NY
11725-4332
US

IV. Provider business mailing address

356 VETERANS MEMORIAL HWY STE 5
COMMACK NY
11725-4332
US

V. Phone/Fax

Practice location:
  • Phone: 347-743-9951
  • Fax: 855-514-2810
Mailing address:
  • Phone: 347-743-9951
  • Fax: 855-514-2810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberF400097
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: