Shaman Kenneth Perera, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

064193 Issued in NY

Practice address

1 Gustave L Levy PL
New York, NY 10029-6504

Phone

(212) 241-0300

NPI assigned

May 4, 2023

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Dr. Kenneth Perera Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1683158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760140800000",
    "number": "1083303176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 GUSTAVE L LEVY PL",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100296500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 GUSTAVE L LEVY PL",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100296504",
            "telephone_number": "212-241-0300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERERA",
        "first_name": "SHAMAN",
        "middle_name": "KENNETH",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-05-04",
        "last_updated": "2025-10-11",
        "certification_date": "2025-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "064193",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KENNETH",
            "last_name": "PERERA",
            "prefix": "DR.",
            "credential": "DDS",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Julian Patrick Perera, MSC CRC CASALT
• Madusha Nicholas Perera
• Marlon Lakmal Perera, MBBS PHD FRACS
• Nelupa Sulani Perera, PHD
• Sauni P Perera, MD
• Sylvia Brinton Perera, LP
• George Peresman, D.C.
• David Peretz, M.D.
• Yelena Perevozkina, M.S. CCC-SLP
• Elene Lucia Pereyra

• General Practice Dentistry in New York, NY
• Providers in New York, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.