Provider Demographics
NPI:1942273479
Name:DELLOTA, MARIA SHERRILYN (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:SHERRILYN
Last Name:DELLOTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:SHERRILYN
Other - Last Name:CHAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1006 CENTRE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-1849
Mailing Address - Country:US
Mailing Address - Phone:970-482-9001
Mailing Address - Fax:970-482-1411
Practice Address - Street 1:1006 CENTRE AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-1849
Practice Address - Country:US
Practice Address - Phone:970-482-9001
Practice Address - Fax:970-482-1411
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40824207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO61858731Medicaid
CO61858731Medicaid
H05512Medicare UPIN