Basic Information
| Provider Information | |||||||||
| NPI: | 1588649479 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAYES | ||||||||
| FirstName: | CHERYLLE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 143067 | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326143067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523335840 | ||||||||
| FaxNumber: | 3523335844 | ||||||||
| Practice Location | |||||||||
| Address1: | 6420 W NEWBERRY RD | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326056621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523335840 | ||||||||
| FaxNumber: | 3523335841 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2005 | ||||||||
| LastUpdateDate: | 09/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | FLME68845 | FL | N | Other Service Providers | Specialist | 2085R0001X | FLME68845 | FL | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 379563200 | 05 | FL | MEDICAID | 001827838 | 01 | FL | UNITED HEALTHCARE | OTHER | 28915 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER | 238479 | 01 | FL | AVMED | OTHER |