Provider Demographics
NPI:1578972089
Name:MITCHELL HERNANDEZ, SHERRYL DENISSE (MD)
Entity Type:Individual
Prefix:
First Name:SHERRYL
Middle Name:DENISSE
Last Name:MITCHELL HERNANDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHERRYL
Other - Middle Name:DENISSE
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:12446 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-2517
Mailing Address - Country:US
Mailing Address - Phone:210-729-2262
Mailing Address - Fax:
Practice Address - Street 1:12446 WEST AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-2517
Practice Address - Country:US
Practice Address - Phone:210-729-2262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-08
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR6443207RN0300X
PR31012207R00000X
PR31744390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR31012OtherJUNTA DE LICENCIAMIENTO Y DISCIPLINA MEDICA