Healthcare Provider Details

I. General information

NPI: 1467858209
Provider Name (Legal Business Name): SHERYL CICCARELLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2014
Last Update Date: 11/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 OLD SHORT HILLS RD
WEST ORANGE NJ
07052-1008
US

IV. Provider business mailing address

351 FRANKLIN RD
DENVILLE NJ
07834-3407
US

V. Phone/Fax

Practice location:
  • Phone: 973-322-4800
  • Fax:
Mailing address:
  • Phone: 201-572-9671
  • Fax: 973-537-9082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00531500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: