Healthcare Provider Details

I. General information

NPI: 1295774891
Provider Name (Legal Business Name): CHERISH DIVINA EBY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 03/07/2023
Certification Date: 03/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 ST PAUL DR STE 207
CHAMBERSBURG PA
17201-1035
US

IV. Provider business mailing address

785 5TH AVENUE SUITE 3
CHAMBERSBURG PA
17201-4232
US

V. Phone/Fax

Practice location:
  • Phone: 717-217-6882
  • Fax: 717-217-6883
Mailing address:
  • Phone: 717-263-9555
  • Fax: 717-217-4217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0002427
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA003067L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberMA003067L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: