Provider Demographics
NPI:1750462776
Name:BROOKS, SHERRY LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:LEE
Last Name:BROOKS
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 1:356 LAKEVIEW ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-6881
Mailing Address - Country:US
Mailing Address - Phone:321-217-2193
Mailing Address - Fax:
Practice Address - Street 1:1417 E CONCORD ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-5409
Practice Address - Country:US
Practice Address - Phone:407-936-2785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0040469207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL042443900Medicaid
FLD62570Medicare UPIN