Healthcare Provider Details

I. General information

NPI: 1356383558
Provider Name (Legal Business Name): CHERYL ANN WRAY MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHERYLE ANN ANDRESEN MA

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 03/06/2020
Certification Date: 03/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5818 HARBOUR VIEW BLVD STE 230D
SUFFOLK VA
23435-3315
US

IV. Provider business mailing address

860 OMNI BLVD STE 101
NEWPORT NEWS VA
23606-4430
US

V. Phone/Fax

Practice location:
  • Phone: 757-673-6118
  • Fax: 757-967-9003
Mailing address:
  • Phone: 757-232-8769
  • Fax: 757-232-8875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number2101 001409
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2201001176
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: