Healthcare Provider Details

I. General information

NPI: 1891620308
Provider Name (Legal Business Name): SHERYL CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 LOFTIS BLVD STE 103
NEWPORT NEWS VA
23606-2999
US

IV. Provider business mailing address

129 PONSONBY DR
YORKTOWN VA
23693-2959
US

V. Phone/Fax

Practice location:
  • Phone: 757-720-0099
  • Fax:
Mailing address:
  • Phone: 717-370-1253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-472451
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: