Provider Demographics
NPI:1528701190
Name:ARCHIBALD, CHERYL A (RN)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:ARCHIBALD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5192 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:LEICESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14481-9766
Mailing Address - Country:US
Mailing Address - Phone:585-739-7231
Mailing Address - Fax:
Practice Address - Street 1:30 BONADONNA AVE
Practice Address - Street 2:
Practice Address - City:MOUNT MORRIS
Practice Address - State:NY
Practice Address - Zip Code:14510-1498
Practice Address - Country:US
Practice Address - Phone:585-658-5000
Practice Address - Fax:585-658-5070
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY532362163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse