Individual
CHERYL BLAIVAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
225 EASTVIEW DR, CENTRAL ISLIP, NY 11722-4539
(631) 665-1600
Mailing address
23 WHITE DR, CEDARHURST, NY 11516-2607
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
12/07/2021
Last updated
12/07/2021
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