Provider Demographics
NPI:1346369972
Name:SANNICOLAS, YUNIUS K (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:YUNIUS
Middle Name:K
Last Name:SANNICOLAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:YUNIUS
Other - Middle Name:K
Other - Last Name:SCHAMBERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-724-2111
Mailing Address - Fax:
Practice Address - Street 1:2401 S 31ST ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76508-0001
Practice Address - Country:US
Practice Address - Phone:254-724-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04372363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA04372OtherTSBME
TX331475901Medicaid
TX331475901Medicaid
TX8D3646Medicare ID - Type UnspecifiedCMS PROVIDER NUMBER
TX341395YK00Medicare PIN