Provider Demographics
NPI:1033372032
Name:HARVEY, SHERYL MAY ALICIA (M,B,B,S)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:MAY ALICIA
Last Name:HARVEY
Suffix:
Gender:F
Credentials:M,B,B,S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CUERO
Mailing Address - State:TX
Mailing Address - Zip Code:77954-2108
Mailing Address - Country:US
Mailing Address - Phone:361-275-2800
Mailing Address - Fax:361-275-3460
Practice Address - Street 1:1109 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CUERO
Practice Address - State:TX
Practice Address - Zip Code:77954-2108
Practice Address - Country:US
Practice Address - Phone:361-275-2800
Practice Address - Fax:361-275-8791
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5811207Q00000X
TXQ7749207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX358022703Medicaid
TX358022704Medicaid
TX358022702Medicaid
TXQ7749OtherTX LIC
TX489560YK7YMedicare PIN
TXQ7749OtherTX LIC