Healthcare Provider Details

I. General information

NPI: 1528048642
Provider Name (Legal Business Name): SHERYL ELAINE RODTS-PALENIK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 PATRIOT ST STE 203
LAFAYETTE LA
70508-6831
US

IV. Provider business mailing address

105 PATRIOT ST STE 203
LAFAYETTE LA
70508-6831
US

V. Phone/Fax

Practice location:
  • Phone: 337-989-9826
  • Fax: 337-989-9829
Mailing address:
  • Phone: 337-989-9826
  • Fax: 337-989-9829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number15090R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: