MEDICARE: SHERRY DIANNE DEKEYSER 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	2084P0800X	Psychiatry Physician	10690	SD
2	2084P0800X	Psychiatry Physician	36746	IA
3	2084P0800X	Psychiatry Physician	50674	AZ
4	2084P0800X	Psychiatry Physician	ME162610	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
2	20589	OTHER	IA	WELLMARK BLUE CROSS BLUE

General Provider Information

NPI Number	:	1518913540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERRY DIANNE DEKEYSER M.D.

Provider Business Mailing Address
First Line	:	3300 N TRIUMPH BLVD STE 500
Second Line	:
City	:	LEHI
State	:	UT
Zip	:	84043-6475
Country	:	US
Telephone Number	:	801-821-2333
Fax Number	:	801-901-1194

Provider Business Practice Location Address
First Line	:	203 FORT WADE RD UNIT 260
Second Line	:
City	:	PONTE VEDRA
State	:	FL
Zip	:	32081-5159
Country	:	US
Telephone Number	:	904-902-4408
Fax Number	:

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

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	04/23/2024

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Directions to “ SHERRY DIANNE DEKEYSER M.D.” Practice Location

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