Provider Demographics
NPI:1194033761
Name:SHAH-FERRUCCIO, PEARLY SUNIL (DDS)
Entity Type:Individual
Prefix:
First Name:PEARLY
Middle Name:SUNIL
Last Name:SHAH-FERRUCCIO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:PEARLY
Other - Middle Name:SUNIL
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3189
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13220-3189
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:737 BROADWAY
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906-3207
Practice Address - Country:US
Practice Address - Phone:781-231-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-17
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1855569122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist