Provider Demographics
NPI:1285378604
Name:RAIMONDI, CHEYENNE ROSE (DPM)
Entity type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:ROSE
Last Name:RAIMONDI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 E MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2826
Mailing Address - Country:US
Mailing Address - Phone:631-982-9343
Mailing Address - Fax:631-724-3164
Practice Address - Street 1:257 E MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2826
Practice Address - Country:US
Practice Address - Phone:631-982-9343
Practice Address - Fax:631-724-3164
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-21
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program