Provider Demographics
NPI:1740572726
Name:COOPER SMITH, SHEILA RENEE
Entity Type:Individual
Prefix:MS
First Name:SHEILA
Middle Name:RENEE
Last Name:COOPER SMITH
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 1:10505 S IH 35
Mailing Address - Street 2:APT 2221
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78747-2656
Mailing Address - Country:US
Mailing Address - Phone:512-520-5319
Mailing Address - Fax:
Practice Address - Street 1:10505 S IH 35
Practice Address - Street 2:APT 2221
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78747-2656
Practice Address - Country:US
Practice Address - Phone:512-520-5319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33510561376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide