Healthcare Provider Details

I. General information

NPI: 1750108825
Provider Name (Legal Business Name): CHERLYN MARY DELEONABREU FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2024
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4811 BUCKLEY RD
LIVERPOOL NY
13088-3676
US

IV. Provider business mailing address

8411 SUTCLIFFE DR
LIVERPOOL NY
13090-1131
US

V. Phone/Fax

Practice location:
  • Phone: 315-457-9966
  • Fax:
Mailing address:
  • Phone: 352-804-9007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF354518-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: