Provider Demographics
NPI:1083303176
Name:PERERA, SHAMAN KENNETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAMAN
Middle Name:KENNETH
Last Name:PERERA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:KENNETH
Other - Middle Name:
Other - Last Name:PERERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1 GUSTAVE L LEVY PL
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 GUSTAVE L LEVY PL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6504
Practice Address - Country:US
Practice Address - Phone:212-241-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program