Healthcare Provider Details

I. General information

NPI: 1760051049
Provider Name (Legal Business Name): ACADIANA MATERNAL FETAL MEDICINE CONSULTING APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2021
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
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 Number
License Number State

VIII. Authorized Official

Name: SHERYL RODTS-PALENIK
Title or Position: OWNER
Credential: MD
Phone: 337-989-9826