Provider Demographics
NPI:1487456463
Name:CHERY, MARIE N C
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:N C
Last Name:CHERY
Suffix:
Gender:
Credentials:
Other - Prefix:MS
Other - First Name:MARIE
Other - Middle Name:N C
Other - Last Name:CHERY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:115 EDGEWOOD AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4585
Mailing Address - Country:US
Mailing Address - Phone:203-440-6392
Mailing Address - Fax:860-283-0114
Practice Address - Street 1:115 EDGEWOOD AVE APT 5
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4585
Practice Address - Country:US
Practice Address - Phone:203-440-6392
Practice Address - Fax:860-283-0114
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTHCA.0002397253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care