Healthcare Provider Details

I. General information

NPI: 1295022036
Provider Name (Legal Business Name): SCHERI-LYN A. MAKOMBE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2011
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 2ND AVE SW
LARGO FL
33770-2298
US

IV. Provider business mailing address

1301 2ND AVE SW
LARGO FL
33770-2298
US

V. Phone/Fax

Practice location:
  • Phone: 727-581-8767
  • Fax: 727-581-3727
Mailing address:
  • Phone: 727-581-8767
  • Fax: 727-581-3727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01072864A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number11016301A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME153100
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: