Provider Demographics
NPI:1538908959
Name:SHADY, CHERYL LYNETTE
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNETTE
Last Name:SHADY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:LYNETTE
Other - Last Name:MURDOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA RMHCI
Mailing Address - Street 1:1969 EUSTACE AVE
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-3907
Mailing Address - Country:US
Mailing Address - Phone:386-847-8392
Mailing Address - Fax:
Practice Address - Street 1:435 S RIDGEWOOD AVE STE 204C-205
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-4927
Practice Address - Country:US
Practice Address - Phone:386-747-6541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25810101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health