Provider Demographics
NPI:1922814342
Name:IANNICCA, CHERYL
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:IANNICCA
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 1:601 DERBY RUN
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44092-2676
Mailing Address - Country:US
Mailing Address - Phone:440-520-8361
Mailing Address - Fax:
Practice Address - Street 1:601 DERBY RUN
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY HILLS
Practice Address - State:OH
Practice Address - Zip Code:44092-2676
Practice Address - Country:US
Practice Address - Phone:440-520-8361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty