Provider Demographics
NPI:1255562534
Name:REYNOLDS, CHERYL LYNN (RN)
Entity type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:LYNN
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:CHERYL
Other - Middle Name:LYNN
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 1499
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-0438
Mailing Address - Country:US
Mailing Address - Phone:631-334-8181
Mailing Address - Fax:
Practice Address - Street 1:59 ADAMS RD
Practice Address - Street 2:APT 2F
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-0438
Practice Address - Country:US
Practice Address - Phone:631-334-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY612552-1163W00000X
NY222376-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No163W00000XNursing Service ProvidersRegistered Nurse