MEDICARE: DR. CHERYL ELAINE DE ZAYAS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	ME0068296	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215937545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHERYL ELAINE DE ZAYAS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 3302
Second Line	:
City	:	HAINES CITY
State	:	FL
Zip	:	33845-3302
Country	:	US
Telephone Number	:	863-422-0924
Fax Number	:	863-422-0150

Provider Business Practice Location Address
First Line	:	115 S 10TH ST
Second Line	:
City	:	HAINES CITY
State	:	FL
Zip	:	33844-5303
Country	:	US
Telephone Number	:	863-422-0924
Fax Number	:	863-422-0150

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	07/08/2007

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