Provider Demographics
NPI:1033095625
Name:CICCARIELLO, SHERRI
Entity type:Individual
Prefix:
First Name:SHERRI
Middle Name:
Last Name:CICCARIELLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SHERRI CICCARIELLO
Mailing Address - Street 2:866 OLD TOWN ROAD
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784
Mailing Address - Country:US
Mailing Address - Phone:631-721-6476
Mailing Address - Fax:631-721-6476
Practice Address - Street 1:SHERRI CICCARIELLO
Practice Address - Street 2:866 OLD TOWN ROAD
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784
Practice Address - Country:US
Practice Address - Phone:631-721-6476
Practice Address - Fax:631-721-6476
Is Sole Proprietor?:No
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018118-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist