Provider Demographics
NPI:1407366420
Name:PERISA, DAWN J
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:J
Last Name:PERISA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:DAWN
Other - Middle Name:
Other - Last Name:KAHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:36 HARLEY AVE.
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731
Mailing Address - Country:US
Mailing Address - Phone:631-662-6161
Mailing Address - Fax:631-266-4503
Practice Address - Street 1:36 HARLEY AVE
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731
Practice Address - Country:US
Practice Address - Phone:631-662-6161
Practice Address - Fax:631-266-4503
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-04
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF402310-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health