Healthcare Provider Details

I. General information

NPI: 1508987918
Provider Name (Legal Business Name): CHERYL CERASOLI R.N.F.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 EAST MAIN STREET PLASTIC AND RECONSTRUCTIVE SURGERY
MOUNT KISCO NY
10549
US

IV. Provider business mailing address

400 EAST MAIN STREET PLASTIC AND RECONSTRUCTIVE SURGERY
MOUNT KISCO NY
10549
US

V. Phone/Fax

Practice location:
  • Phone: 914-242-7610
  • Fax: 914-241-3239
Mailing address:
  • Phone: 914-242-7610
  • Fax: 914-241-3239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number50525163
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: