MEDICARE: CHERYL POLLIDORE NURSE PRACTITIONER

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	363LF0000X	Family Nurse Practitioner	F346563-01	NY

General Provider Information

NPI Number	:	1316266745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL POLLIDORE NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	21 GRAND AVE
Second Line	:
City	:	MIDDLETOWN
State	:	NY
Zip	:	10940-4019
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 GRAND AVE
Second Line	:
City	:	MIDDLETOWN
State	:	NY
Zip	:	10940-4019
Country	:	US
Telephone Number	:	845-343-3874
Fax Number	:

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

Provider Enumeration Date	:	05/25/2010
Last Update Date	:	01/05/2021

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