Provider Demographics
NPI:1053444232
Name:CHEEVERS, BRIAN M
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:M
Last Name:CHEEVERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 CHESHIRE LN N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-3706
Mailing Address - Country:US
Mailing Address - Phone:763-268-4169
Mailing Address - Fax:763-268-4240
Practice Address - Street 1:6200 20TH ST
Practice Address - Street 2:SUITE 776
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32966-1012
Practice Address - Country:US
Practice Address - Phone:772-778-3448
Practice Address - Fax:772-778-7838
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS4059237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist