Provider Demographics
NPI:1912042748
Name:CIPOLLA, SHEILA
Entity Type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:
Last Name:CIPOLLA
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:SHEILA
Other - Middle Name:
Other - Last Name:HENNESSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1113 AVALON SQ
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2845
Mailing Address - Country:US
Mailing Address - Phone:516-801-3789
Mailing Address - Fax:
Practice Address - Street 1:1103 STEWART AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4886
Practice Address - Country:US
Practice Address - Phone:516-745-0688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051689-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist