Basic Information
Provider Information
NPI: 1326224544
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GUGGEMOS
FirstName: CHERYL
MiddleName: ANN
NamePrefix:  
NameSuffix:  
Credential: OT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 303 TERRACE BLVD
Address2:  
City: DEPEW
State: NY
PostalCode: 140433028
CountryCode: US
TelephoneNumber: 7166852243
FaxNumber:  
Practice Location
Address1: 40 CENTRE DR
Address2:  
City: ORCHARD PARK
State: NY
PostalCode: 141274100
CountryCode: US
TelephoneNumber: 7166672294
FaxNumber: 7166672272
Other Information
ProviderEnumerationDate: 01/17/2008
LastUpdateDate: 03/29/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
174400000X0116551NYY Other Service ProvidersSpecialist 

No ID Information.


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