MEDICARE: CRYSTAL CHERRY

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	163W00000X	Registered Nurse	949043	NY

General Provider Information

NPI Number	:	1679437354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL CHERRY

Provider Business Mailing Address
First Line	:	9229 GUY R BREWER BLVD APT 1106
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11433-2222
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3030 47TH AVE
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-3433
Country	:	US
Telephone Number	:	718-391-8300
Fax Number	:

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

Provider Enumeration Date	:	12/16/2025
Last Update Date	:	12/16/2025

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Directions to “ CRYSTAL CHERRY ” Practice Location

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