Provider Demographics
NPI:1386255966
Name:FEDICH, CHERYL DIANE (AS, BS CASE MGR)
Entity type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:DIANE
Last Name:FEDICH
Suffix:
Gender:F
Credentials:AS, BS CASE MGR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3513 SMITH DR
Mailing Address - Street 2:
Mailing Address - City:ENDWELL
Mailing Address - State:NY
Mailing Address - Zip Code:13760-2350
Mailing Address - Country:US
Mailing Address - Phone:607-760-4880
Mailing Address - Fax:607-785-1869
Practice Address - Street 1:3513 SMITH DR
Practice Address - Street 2:
Practice Address - City:ENDWELL
Practice Address - State:NY
Practice Address - Zip Code:13760-2350
Practice Address - Country:US
Practice Address - Phone:607-760-4880
Practice Address - Fax:607-785-1869
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-16
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health