1013900406 NPI number — DR. SHERRI LYN DEHAAS MD

Table of content: DR. SHERRI LYN DEHAAS MD (NPI 1013900406)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013900406 NPI number — DR. SHERRI LYN DEHAAS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEHAAS
Provider First Name:
SHERRI
Provider Middle Name:
LYN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OREZZOLI
Provider Other First Name:
SHERRI
Provider Other Middle Name:
LYN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1013900406
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
148 CONVENT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BENNINGTON
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05201-1709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-753-7553
Provider Business Mailing Address Fax Number:
802-753-7553

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
148 CONVENT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BENNINGTON
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05201-1709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-753-7553
Provider Business Practice Location Address Fax Number:
802-753-7553
Provider Enumeration Date:
08/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  60 249093 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 042-0011611 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: MD-074113-L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 925577 . This is a "BC/BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0019050740008 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P004532 . This is a "GATEWAY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 55470 . This is a "GEISINGER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7473379 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 080185013 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 116912700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com