Provider Demographics
NPI:1083023519
Name:BERRY, SHIREE A (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIREE
Middle Name:A
Last Name:BERRY
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 1:4001 W 15TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5855
Mailing Address - Country:US
Mailing Address - Phone:972-608-2025
Mailing Address - Fax:972-608-2032
Practice Address - Street 1:4001 W 15TH ST STE 200
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5855
Practice Address - Country:US
Practice Address - Phone:972-608-2025
Practice Address - Fax:972-608-2032
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-08
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ1090208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery