Provider Demographics
NPI:1750866414
Name:SHEDRICK, JOYCE MARIE
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:MARIE
Last Name:SHEDRICK
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 1:5050 CRENSHAW RD STE 200
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-3139
Mailing Address - Country:US
Mailing Address - Phone:281-998-2488
Mailing Address - Fax:281-998-2482
Practice Address - Street 1:5050 CRENSHAW RD STE 200
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-3139
Practice Address - Country:US
Practice Address - Phone:281-998-2499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-28
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX134797363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner