Provider Demographics
NPI:1932493830
Name:DIVITO, SHERRIE JILL (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:SHERRIE
Middle Name:JILL
Last Name:DIVITO
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 AVENUE LOUIS PASTEUR
Mailing Address - Street 2:671 HIM
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5727
Mailing Address - Country:US
Mailing Address - Phone:617-732-5500
Mailing Address - Fax:
Practice Address - Street 1:77 AVENUE LOUIS PASTEUR
Practice Address - Street 2:671 HIM
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5727
Practice Address - Country:US
Practice Address - Phone:617-732-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA262576207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology