Healthcare Provider Details

I. General information

NPI: 1104273697
Provider Name (Legal Business Name): CHERYL DUMOND-MARTINEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 01/22/2026
Certification Date: 01/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 BROAD ROAD STE 1D SOUTH
SYRACUSE NY
13215
US

IV. Provider business mailing address

4900 BROAD ROAD STE 1D SOUTH
SYRACUSE NY
13215
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-8224
  • Fax: 315-464-2187
Mailing address:
  • Phone: 315-464-8224
  • Fax: 315-464-2187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number298696
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: