Provider Demographics
NPI:1336164235
Name:PEARL, SHERYL ANN (MD)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:ANN
Last Name:PEARL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 MAIN ST
Mailing Address - Street 2:SUITE 408
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-1000
Mailing Address - Country:US
Mailing Address - Phone:866-662-4560
Mailing Address - Fax:877-279-9425
Practice Address - Street 1:45 MAIN ST
Practice Address - Street 2:SUITE 408
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-1000
Practice Address - Country:US
Practice Address - Phone:866-662-4560
Practice Address - Fax:877-279-9425
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206758207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02157404Medicaid
NYG55761Medicare UPIN
NY02157404Medicaid
P00399642Medicare PIN