1386255966 NPI number — MS. CHERYL DIANE FEDICH AS, BS. CASE MGR.

Table of content: MS. CHERYL DIANE FEDICH AS, BS. CASE MGR. (NPI 1386255966)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386255966 NPI number — MS. CHERYL DIANE FEDICH AS, BS. CASE MGR.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FEDICH
Provider First Name:
CHERYL
Provider Middle Name:
DIANE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
AS, BS. CASE MGR.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386255966
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3513 SMITH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENDWELL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13760-2350
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-760-4880
Provider Business Mailing Address Fax Number:
607-785-1869

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3513 SMITH DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENDWELL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13760-2350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-760-4880
Provider Business Practice Location Address Fax Number:
607-785-1869
Provider Enumeration Date:
08/16/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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