Provider Demographics
NPI:1083610224
Name:DEVAUGH, SHEILA DIAN (APRN)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:DIAN
Last Name:DEVAUGH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 N 11TH ST STE P2200
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1513
Mailing Address - Country:US
Mailing Address - Phone:409-892-1192
Mailing Address - Fax:409-924-7511
Practice Address - Street 1:755 N 11TH ST
Practice Address - Street 2:STE. P2200
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702
Practice Address - Country:US
Practice Address - Phone:409-892-1192
Practice Address - Fax:409-892-6792
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX253941363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092937401Medicaid
TX83N963Medicare ID - Type Unspecified