Provider Demographics
NPI:1013900406
Name:DEHAAS, SHERRI LYN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHERRI
Middle Name:LYN
Last Name:DEHAAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHERRI
Other - Middle Name:LYN
Other - Last Name:OREZZOLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:148 CONVENT AVE
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-1709
Mailing Address - Country:US
Mailing Address - Phone:802-753-7553
Mailing Address - Fax:802-753-7553
Practice Address - Street 1:148 CONVENT AVE
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-1709
Practice Address - Country:US
Practice Address - Phone:802-753-7553
Practice Address - Fax:802-753-7553
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60 249093207Q00000X
VT042-0011611207Q00000X
PAMD-074113-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA925577OtherBC/BS
PA0019050740008Medicaid
P004532OtherGATEWAY
PA55470OtherGEISINGER
PA7473379OtherAETNA
080185013OtherRR MEDICARE
PA7473379OtherAETNA
PA0019050740008Medicaid