Basic Information
| Provider Information | |||||||||
| NPI: | 1841266012 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARIANO-PERUGINI | ||||||||
| FirstName: | CHERYL | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 NEPONSET ST FL STREET2 | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016062714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083685532 | ||||||||
| FaxNumber: | 5087219106 | ||||||||
| Practice Location | |||||||||
| Address1: | 385 SOUTHBRIDGE ST | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015012498 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087211180 | ||||||||
| FaxNumber: | 5087219106 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2006 | ||||||||
| LastUpdateDate: | 03/19/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 208928 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 042472266 | 01 | PRIVATE HELATHCARE SYSTEM | OTHER | NP1021 | 01 | BLUE SHIELD INDEMNITY | OTHER | 042472266 | 01 | THREE RIVERS | OTHER | 57173 | 01 | FALLON COMMUNITY HEALTH | OTHER | 40682 | 01 | CHILDRENS MEDICAL SECURIT | OTHER | AA3615 | 01 | HARVARD PILGRIM | OTHER | 0701131 | 05 | MA | MEDICAID |