Provider Demographics
NPI:1295022036
Name:MAKOMBE, SCHERI-LYN A (MD)
Entity Type:Individual
Prefix:
First Name:SCHERI-LYN
Middle Name:A
Last Name:MAKOMBE
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 1:1301 2ND AVE SW
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-2298
Mailing Address - Country:US
Mailing Address - Phone:727-581-8767
Mailing Address - Fax:727-581-3727
Practice Address - Street 1:1301 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-2298
Practice Address - Country:US
Practice Address - Phone:727-581-8767
Practice Address - Fax:727-581-3727
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01072864A207Q00000X
IN11016301A390200000X
FLME153100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01424380OtherRR MEDICARE
IN201068180Medicaid
FLK0M8MOtherFL BLUE