Provider Demographics
NPI:1912569054
Name:SY, SHEILA CARBALLO (MSN, CPNP-AC)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:CARBALLO
Last Name:SY
Suffix:
Gender:F
Credentials:MSN, CPNP-AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 LAW ST APT 456
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-1277
Mailing Address - Country:US
Mailing Address - Phone:917-346-6697
Mailing Address - Fax:
Practice Address - Street 1:6431 FANNIN STREET
Practice Address - Street 2:MSB 5.232
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77003
Practice Address - Country:US
Practice Address - Phone:713-500-7174
Practice Address - Fax:713-500-7296
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20198889363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX20198889Medicaid