| Doctor Name: | CHERYL A MOORE |
| NPI Number: | 1003146945 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NPP |
| License Number: | F4000971 |
| Business Practice Address: | 22 North Rd Northport, NY - 117682840 |
| Business Phone Number: | 6318487104 |
| Business Fax Number: | |
| Mailing Address: | 22 North Rd, NORTHPORT |
| State: | NY |
| Postal Code: | 117682840 |
| Phone Number: | 6318487104 |
| Fax Number: | |
| NPI Enumeration Date: | 12/26/2009 |
| NPI Last Update Date: | 12/26/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 364SP0808X |
| License Number: | F4000971 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Clinical Nurse Specialist |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |