Healthcare Provider Details

I. General information

NPI: 1376002535
Provider Name (Legal Business Name): SHERIEN GEORGE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4131 SPICEWOOD SPRINGS RD STE L2
AUSTIN TX
78759-8652
US

IV. Provider business mailing address

1525 ARROWHEAD LN
CARROLLTON TX
75007-6021
US

V. Phone/Fax

Practice location:
  • Phone: 512-732-2122
  • Fax: 512-732-2124
Mailing address:
  • Phone: 972-369-5089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA12486
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: