Provider Demographics
NPI:1215673892
Name:ANDERSON, CHERYL (SBD)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:SBD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N ESTRELLA PKWY # B2-429
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-4135
Mailing Address - Country:US
Mailing Address - Phone:623-499-2341
Mailing Address - Fax:
Practice Address - Street 1:18122 W DESERT VIEW LN
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-5065
Practice Address - Country:US
Practice Address - Phone:623-256-7470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-07
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ374J00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician