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General NPI Number Information
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NPI Number | 1396540969
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Entity Type | Individual
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Provider Name | MICHAEL JOSEPH PEREIRA III DNP CRNA
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Gender | Male
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Dates
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Enumeration Date | 02/17/2025
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 4900 BROAD RD
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City | SYRACUSE
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State | NY
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Zip | 13215-2265
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Country | US
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Telephone | 315-492-5011
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Fax |
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Provider Business Mailing Address
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Address Line | 265C EVANS ST APT 8
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City | BUFFALO
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State | NY
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Zip | 14221-5604
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Country | US
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Telephone | 845-901-7834
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 154236
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License Number State | NY
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