Provider Demographics
NPI:1215936950
Name:SLAVINSKI, CHERYL M (PA)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:M
Last Name:SLAVINSKI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BARCLAY DR
Mailing Address - Street 2:
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707-8912
Mailing Address - Country:US
Mailing Address - Phone:302-992-9617
Mailing Address - Fax:302-992-9633
Practice Address - Street 1:4512 KIRKWOOD HWY
Practice Address - Street 2:SUITE 300
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5123
Practice Address - Country:US
Practice Address - Phone:302-992-9617
Practice Address - Fax:302-992-9633
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC50000338363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000023204Medicaid
011134L40Medicare ID - Type Unspecified
DE1000023204Medicaid