Healthcare Provider Details

I. General information

NPI: 1174459812
Provider Name (Legal Business Name): CHEYANNE WALLER AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 BLOOMFIELD DR STE 108
LITITZ PA
17543-7792
US

IV. Provider business mailing address

407 SUSAN AVE
STRASBURG PA
17579-1042
US

V. Phone/Fax

Practice location:
  • Phone: 717-584-8162
  • Fax:
Mailing address:
  • Phone: 717-940-1606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAT007101
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: