Provider Demographics
NPI:1447675707
Name:WONG, CHERYL (ND, LAC)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SPERRY RD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-7240
Mailing Address - Country:US
Mailing Address - Phone:314-799-0355
Mailing Address - Fax:
Practice Address - Street 1:3 FRANKLIN SQ
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-2153
Practice Address - Country:US
Practice Address - Phone:518-288-7083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005274171100000X
VT099.0100829175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No175F00000XOther Service ProvidersNaturopath