Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 005730 | CT |
NPI | 1063794808 |
---|---|
Provider Name | Sheryl Ficorilli |
First Address | Willimantic, CT 06226-1948 |
Second Address | Willimantic, CT 06226-1948 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2011 |
Last Update Date | 19/09/2011 |