Provider Demographics
NPI:1023023421
Name:SHARYLAND IMAGING CENTER
Entity Type:Organization
Organization Name:SHARYLAND IMAGING CENTER
Other - Org Name:SHARYLAND IMAGING CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAVAZOS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:956-583-7007
Mailing Address - Street 1:2121 E GRIFFIN PKWY STE 2
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3072
Mailing Address - Country:US
Mailing Address - Phone:956-583-7003
Mailing Address - Fax:
Practice Address - Street 1:2121 E GRIFFIN PKWY STE 2
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3072
Practice Address - Country:US
Practice Address - Phone:956-583-7003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR28874261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology