MEDICARE: MRS. CHERYL SUZANNE PREDMORE MS CCC/SLP-L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	015793-1	NY

General Provider Information

NPI Number	:	1053622076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHERYL SUZANNE PREDMORE MS CCC/SLP-L

Provider Business Mailing Address
First Line	:	28032 STONY POINT RD
Second Line	:
City	:	CAPE VINCENT
State	:	NY
Zip	:	13618-3140
Country	:	US
Telephone Number	:	585-732-7348
Fax Number	:

Provider Business Practice Location Address
First Line	:	28032 STONY POINT RD
Second Line	:
City	:	CAPE VINCENT
State	:	NY
Zip	:	13618-3140
Country	:	US
Telephone Number	:	585-732-7348
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2010
Last Update Date	:	06/24/2010

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