Provider Demographics
NPI:1154707693
Name:CHENG, JUDY (MD)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:CHENG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3233 SW 33RD ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474
Mailing Address - Country:US
Mailing Address - Phone:352-237-2322
Mailing Address - Fax:352-237-2456
Practice Address - Street 1:3233 SW 33RD ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474
Practice Address - Country:US
Practice Address - Phone:352-237-2322
Practice Address - Fax:352-237-2456
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-06
Last Update Date:2022-08-22
Deactivation Date:2022-07-21
Deactivation Code:
Reactivation Date:2022-08-10
Provider Licenses
StateLicense IDTaxonomies
IL036152092207N00000X
MA267330207N00000X
FLME115587207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology