Provider Demographics
NPI:1558414326
Name:ANDERSON, SHERYL P (CP, LPO)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:P
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CP, LPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1457
Mailing Address - Street 2:
Mailing Address - City:HALLSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75650-1457
Mailing Address - Country:US
Mailing Address - Phone:903-452-2041
Mailing Address - Fax:903-668-2905
Practice Address - Street 1:4110 NORTH ST
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1817
Practice Address - Country:US
Practice Address - Phone:936-559-1881
Practice Address - Fax:936-559-1890
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX46222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX325159701Medicaid
TX325159702Medicaid
TX530189OtherBLUE CROSS & BLUE SHIELD
ID806279800Medicaid
TX530189OtherBLUE CROSS & BLUE SHIELD