Provider Demographics
NPI:1497509483
Name:CLINKSCALES, CHEYENNE NICOLE (PA-C)
Entity type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:NICOLE
Last Name:CLINKSCALES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 FULTON AVE STE 607
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-3901
Mailing Address - Country:US
Mailing Address - Phone:516-566-0658
Mailing Address - Fax:
Practice Address - Street 1:250 FULTON AVE STE 607
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-3901
Practice Address - Country:US
Practice Address - Phone:516-566-0658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031727363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant