Provider Demographics
NPI:1558329672
Name:SPERDUTI CERRILLO, MARY CATHERINE (ANP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:CATHERINE
Last Name:SPERDUTI CERRILLO
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:CERRILLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ANP
Mailing Address - Street 1:3262 KENDRICK PL
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-3656
Mailing Address - Country:US
Mailing Address - Phone:716-646-6454
Mailing Address - Fax:
Practice Address - Street 1:60 INNSBRUCK DR
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14227-2735
Practice Address - Country:US
Practice Address - Phone:716-668-7051
Practice Address - Fax:716-668-7069
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303205363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY303205OtherSTATE LICENSE NUMBER
NY303205OtherSTATE LICENSE NUMBER