Healthcare Provider Details

I. General information

NPI: 1902830318
Provider Name (Legal Business Name): SHERALYN DEBORAH WOOD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 01/20/2020
Certification Date: 01/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 E BANDERA RD SUITE 304
BOERNE TX
78006-2849
US

IV. Provider business mailing address

19238 STONEHUE
SAN ANTONIO TX
78258-3447
US

V. Phone/Fax

Practice location:
  • Phone: 830-816-5055
  • Fax: 830-816-5056
Mailing address:
  • Phone: 210-494-2223
  • Fax: 210-494-6516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberK0403
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: