MEDICARE: SHERRI LEE MAETOZO MD PA

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	207V00000X	Obstetrics & Gynecology Physician	ME0056926	FL

General Provider Information

NPI Number	:	1710206925
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHERRI LEE MAETOZO MD PA

Provider Business Mailing Address
First Line	:	1301 PLANTATION ISLAND DRIVE
Second Line	:	STE 103
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32080-3109
Country	:	US
Telephone Number	:	904-461-5330
Fax Number	:	904-461-5334

Provider Business Practice Location Address
First Line	:	1301 PLANTATION ISLAND DRIVE
Second Line	:	STE 103
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32080-3109
Country	:	US
Telephone Number	:	904-461-5330
Fax Number	:	904-461-5334

Authorized Official
Title or Position	:	CEO MEDICAL DOCTOR
Name	:	DR. SHERRI LEE MAETOZO
Credential	:	MD
Telephone Number	:	904-461-5330

Provider Enumeration Date	:	05/27/2010
Last Update Date	:	05/27/2010

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