Healthcare Provider Details

I. General information

NPI: 1619898251
Provider Name (Legal Business Name): CHEYENNE SAMANTHA MYERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13420 109TH AVE
SOUTH OZONE PARK NY
11420-1802
US

IV. Provider business mailing address

13420 109TH AVE
SOUTH OZONE PARK NY
11420-1802
US

V. Phone/Fax

Practice location:
  • Phone: 347-904-5427
  • Fax:
Mailing address:
  • Phone: 347-904-5427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: