Provider Demographics
NPI:1770601718
Name:NICOLAIS, MARY SCIARRINO
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:SCIARRINO
Last Name:NICOLAIS
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:JOSEPHINE
Other - Last Name:SCIARRINO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3150 ERIE BLVD EAST
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:NY
Mailing Address - Zip Code:13214
Mailing Address - Country:US
Mailing Address - Phone:315-446-7442
Mailing Address - Fax:315-446-7449
Practice Address - Street 1:3150 ERIE BLVD EAST
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:NY
Practice Address - Zip Code:13214
Practice Address - Country:US
Practice Address - Phone:315-446-7442
Practice Address - Fax:315-446-7449
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY373791122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist