Provider Demographics
NPI:1841266012
Name:MARIANO-PERUGINI, CHERYL L (NP)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:L
Last Name:MARIANO-PERUGINI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5 NEPONSET ST FL STREET2
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2714
Mailing Address - Country:US
Mailing Address - Phone:508-368-5532
Mailing Address - Fax:508-721-9106
Practice Address - Street 1:385 SOUTHBRIDGE ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-2498
Practice Address - Country:US
Practice Address - Phone:508-721-1180
Practice Address - Fax:508-721-9106
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208928363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
042472266OtherPRIVATE HELATHCARE SYSTEM
NP1021OtherBLUE SHIELD INDEMNITY
042472266OtherTHREE RIVERS
57173OtherFALLON COMMUNITY HEALTH
40682OtherCHILDRENS MEDICAL SECURIT
AA3615OtherHARVARD PILGRIM
MA0701131Medicaid
042472266OtherTHREE RIVERS
40682OtherCHILDRENS MEDICAL SECURIT