Provider Demographics
NPI:1891726980
Name:MURRAY, CHERYL LYN (PA-C)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYN
Last Name:MURRAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:LYN
Other - Last Name:HEINTZELMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:130 BIRDSEYE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2444
Mailing Address - Country:US
Mailing Address - Phone:860-840-7300
Mailing Address - Fax:860-840-7300
Practice Address - Street 1:130 BIRDSEYE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2444
Practice Address - Country:US
Practice Address - Phone:860-840-7300
Practice Address - Fax:860-840-7300
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X
CT001866363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001866OtherLICENSE
DEC5-0000401OtherLICENSE