Healthcare Provider Details

I. General information

NPI: 1063794808
Provider Name (Legal Business Name): SHERYL FICORILLI RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2011
Last Update Date: 09/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 MAIN ST
WILLIMANTIC CT
06226-1948
US

IV. Provider business mailing address

1315 MAIN ST
WILLIMANTIC CT
06226-1948
US

V. Phone/Fax

Practice location:
  • Phone: 860-450-7471
  • Fax: 860-450-7396
Mailing address:
  • Phone: 860-450-7471
  • Fax: 860-450-7396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number005730
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: