Provider Demographics
NPI:1235177619
Name:CANTANELLI, SHEEBA M (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SHEEBA
Middle Name:M
Last Name:CANTANELLI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHEEBA
Other - Middle Name:M
Other - Last Name:BABU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-645-4673
Mailing Address - Fax:214-648-4084
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7201
Practice Address - Country:US
Practice Address - Phone:214-645-4673
Practice Address - Fax:214-648-4084
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04090363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB113055Medicare PIN
TXTXB117846Medicare PIN
TXP08272Medicare UPIN
TX8B9142Medicare PIN