Provider Demographics
NPI:1922565167
Name:CHERY, REGINALD
Entity type:Individual
Prefix:
First Name:REGINALD
Middle Name:
Last Name:CHERY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 AUGUSTA WAY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-3572
Mailing Address - Country:US
Mailing Address - Phone:407-924-0961
Mailing Address - Fax:
Practice Address - Street 1:3660 MAGUIRE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-3059
Practice Address - Country:US
Practice Address - Phone:407-674-6870
Practice Address - Fax:407-674-6873
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5224479164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse