Provider Demographics
NPI:1215937545
Name:DE ZAYAS, CHERYL ELAINE (MD)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:ELAINE
Last Name:DE ZAYAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3302
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33845-3302
Mailing Address - Country:US
Mailing Address - Phone:863-422-0924
Mailing Address - Fax:863-422-0150
Practice Address - Street 1:115 S 10TH ST
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-5303
Practice Address - Country:US
Practice Address - Phone:863-422-0924
Practice Address - Fax:863-422-0150
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0068296208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377734100Medicaid
FL377734100Medicaid