Provider Demographics
NPI:1619991197
Name:GRAHAM, SHEILA RAE
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:RAE
Last Name:GRAHAM
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 1:105 CANYON LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:TX
Mailing Address - Zip Code:77657-3701
Mailing Address - Country:US
Mailing Address - Phone:409-200-2220
Mailing Address - Fax:
Practice Address - Street 1:105 CANYON LAKE CIR
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:TX
Practice Address - Zip Code:77657-3701
Practice Address - Country:US
Practice Address - Phone:409-200-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85540101YP2500X, 101YP2500X
246W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No246W00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Cardiology