MEDICARE: SHERI BREANNE O'LEARY PA-C, MPAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA05159	TX

General Provider Information

NPI Number	:	1003937160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERI BREANNE O'LEARY PA-C, MPAS

Provider Business Mailing Address
First Line	:	1320 DIAN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-3706
Country	:	US
Telephone Number	:	281-703-0207
Fax Number	:

Provider Business Practice Location Address
First Line	:	1155 PRESSLER ST
Second Line	:	DEPARTMENT OF BREAST MEDICAL ONCOLOGY- UNIT 1354
City	:	HOUSTON
State	:	TX
Zip	:	77030-3721
Country	:	US
Telephone Number	:	713-563-8984
Fax Number	:	713-563-0910

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	12/27/2007

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