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NPI Code Detail

MEDICARE: CHERYL GUSTIN

MEDICARE: CHERYL GUSTIN
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
1102L00000XPsychoanalyst

General Provider Information

NPI Number : 1225798887
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHERYL GUSTIN
Provider Business Mailing Address
First Line : 1730 E 12TH ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46201-1170
Country : US
Telephone Number : 317-294-4109
Fax Number :
Provider Business Practice Location Address
First Line : 6330 DIGITAL WAY
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46278-1667
Country : US
Telephone Number : 317-449-2790
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/23/2021
Last Update Date : 12/23/2021

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Directions to “ CHERYL GUSTIN ” Practice Location

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