Provider Demographics
NPI:1467741090
Name:GUIMONT, SHEREE MIREILLE
Entity Type:Individual
Prefix:MS
First Name:SHEREE
Middle Name:MIREILLE
Last Name:GUIMONT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3434 W ILLINOIS AVE STE 3063
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75211-8709
Mailing Address - Country:US
Mailing Address - Phone:214-623-1900
Mailing Address - Fax:
Practice Address - Street 1:3434 W ILLINOIS AVE STE 3063
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-8709
Practice Address - Country:US
Practice Address - Phone:214-623-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ0059208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program