Provider Demographics
NPI:1386536704
Name:MATYAC, CHEYENNE MICHELLE
Entity type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:MICHELLE
Last Name:MATYAC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19526 EAGLE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FORESTHILL
Mailing Address - State:CA
Mailing Address - Zip Code:95631-9702
Mailing Address - Country:US
Mailing Address - Phone:530-320-8830
Mailing Address - Fax:
Practice Address - Street 1:6 TARMAN DR
Practice Address - Street 2:
Practice Address - City:CLOVERDALE
Practice Address - State:CA
Practice Address - Zip Code:95425-3932
Practice Address - Country:US
Practice Address - Phone:707-894-4229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-18
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95035942363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner