Healthcare Provider Details

I. General information

NPI: 1033095625
Provider Name (Legal Business Name): SHERRI CICCARIELLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2025
Last Update Date: 08/12/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SHERRI CICCARIELLO 866 OLD TOWN ROAD
SELDEN NY
11784
US

IV. Provider business mailing address

SHERRI CICCARIELLO 866 OLD TOWN ROAD
SELDEN NY
11784
US

V. Phone/Fax

Practice location:
  • Phone: 631-721-6476
  • Fax: 631-721-6476
Mailing address:
  • Phone: 631-721-6476
  • Fax: 631-721-6476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number018118-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: