=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376007278
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHANIE CHERY PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2019
-----------------------------------------------------
Last Update Date | 02/14/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7421 N UNIVERSITY DR STE 107
-----------------------------------------------------
City | TAMARAC
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33321-2952
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-726-0095
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7852 NW 62ND TER
-----------------------------------------------------
City | PARKLAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33067-3349
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-397-5263
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 9111877
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------