Provider Demographics
NPI:1225281470
Name:VASSALLO, SHERYL LISA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHERYL
Middle Name:LISA
Last Name:VASSALLO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-1735
Mailing Address - Country:US
Mailing Address - Phone:844-362-1735
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:150 NEW PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:MOUNTAINSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07092-2590
Practice Address - Country:US
Practice Address - Phone:908-233-3720
Practice Address - Fax:908-301-5430
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-01
Last Update Date:2020-11-02
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA08431000208000000X, 2080H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080H0002XAllopathic & Osteopathic PhysiciansPediatricsHospice and Palliative Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics