Provider Demographics
NPI:1588270276
Name:GANNON, CHERYL LYNN (MED)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNN
Last Name:GANNON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOMERSWORTH
Mailing Address - State:NH
Mailing Address - Zip Code:03878-3099
Mailing Address - Country:US
Mailing Address - Phone:603-692-4411
Mailing Address - Fax:
Practice Address - Street 1:317 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOMERSWORTH
Practice Address - State:NH
Practice Address - Zip Code:03878-3099
Practice Address - Country:US
Practice Address - Phone:603-692-4411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255R0406XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistRehabilitation, Blind