Provider Demographics
NPI:1245459536
Name:GOMES, SHERYL (DMD)
Entity type:Individual
Prefix:
First Name:SHERYL
Middle Name:
Last Name:GOMES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:SHERYL
Other - Middle Name:
Other - Last Name:GOMES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:867 RENSSELAER AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-2312
Mailing Address - Country:US
Mailing Address - Phone:917-476-6366
Mailing Address - Fax:
Practice Address - Street 1:3371 FULTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-2033
Practice Address - Country:US
Practice Address - Phone:718-827-7812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0463411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01742896Medicaid