Provider Demographics
NPI:1962702688
Name:PERILLO, DENICE MARIE (MS ED)
Entity type:Individual
Prefix:MRS
First Name:DENICE
Middle Name:MARIE
Last Name:PERILLO
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 RUE MADELEINE WAY
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-9425
Mailing Address - Country:US
Mailing Address - Phone:176-684-7273
Mailing Address - Fax:
Practice Address - Street 1:51 ST JOHNS PARKSIDE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14210-2515
Practice Address - Country:US
Practice Address - Phone:176-828-9560
Practice Address - Fax:716-828-9460
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist