MEDICARE: SHERYL P. ANDERSON CP, LPO

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	222Z00000X	Orthotist	46	TX
2	224P00000X	Prosthetist	46	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	530189	OTHER	TX	BLUE CROSS & BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558414326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERYL P. ANDERSON CP, LPO

Provider Business Mailing Address
First Line	:	PO BOX 1457
Second Line	:
City	:	HALLSVILLE
State	:	TX
Zip	:	75650-1457
Country	:	US
Telephone Number	:	903-452-2041
Fax Number	:	903-668-2905

Provider Business Practice Location Address
First Line	:	4110 NORTH ST
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-1817
Country	:	US
Telephone Number	:	936-559-1881
Fax Number	:	936-559-1890

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

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	01/18/2021

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