Provider Demographics
NPI:1679871768
Name:DETIQUEZ, SHERRILYN PALOMARES (MD)
Entity Type:Individual
Prefix:DR
First Name:SHERRILYN
Middle Name:PALOMARES
Last Name:DETIQUEZ
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 1:1324 LAKELAND HILLS BLVD.
Mailing Address - Street 2:ATTN: MANAGED CARE DEPT.
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-4543
Mailing Address - Country:US
Mailing Address - Phone:863-284-1611
Mailing Address - Fax:
Practice Address - Street 1:4710 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2165
Practice Address - Country:US
Practice Address - Phone:863-284-6800
Practice Address - Fax:863-284-6824
Is Sole Proprietor?:No
Enumeration Date:2011-03-14
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109381207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFJ202ZMedicare PIN