Healthcare Provider Details

I. General information

NPI: 1033380134
Provider Name (Legal Business Name): CHERYLANNE SMITH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3587 GRIFFIN RD
SYRACUSE NY
13215-9525
US

IV. Provider business mailing address

3587 GRIFFIN RD
SYRACUSE NY
13215-9525
US

V. Phone/Fax

Practice location:
  • Phone: 315-498-4942
  • Fax:
Mailing address:
  • Phone: 315-498-4942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number536150-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number536150-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: