Provider Demographics
NPI:1679966535
Name:PEZZULLO, CHERYLINE
Entity Type:Individual
Prefix:DR
First Name:CHERYLINE
Middle Name:
Last Name:PEZZULLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 WHARTON DR
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-7431
Mailing Address - Country:US
Mailing Address - Phone:914-729-4243
Mailing Address - Fax:
Practice Address - Street 1:16 WHARTON DR
Practice Address - Street 2:
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567-7431
Practice Address - Country:US
Practice Address - Phone:914-729-4243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-16
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY05874911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice