Provider Demographics
NPI:1477644748
Name:MUNDY, SHEILA (MD)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:MUNDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S 12TH ST
Mailing Address - Street 2:PO BOX 890
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76701-1810
Mailing Address - Country:US
Mailing Address - Phone:254-297-7004
Mailing Address - Fax:
Practice Address - Street 1:110 S 12TH ST
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76701-1810
Practice Address - Country:US
Practice Address - Phone:254-297-7004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL04382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry