Provider Demographics
NPI:1063249183
Name:MAGERKO, CHEYANNE ROSE (MA)
Entity type:Individual
Prefix:MRS
First Name:CHEYANNE
Middle Name:ROSE
Last Name:MAGERKO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8618 FOX CHASE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-0411
Mailing Address - Country:US
Mailing Address - Phone:812-620-9136
Mailing Address - Fax:
Practice Address - Street 1:9700 RESEARCH DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-8552
Practice Address - Country:US
Practice Address - Phone:910-585-6198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-14
Last Update Date:2024-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA20544101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health