Healthcare Provider Details

I. General information

NPI: 1275518722
Provider Name (Legal Business Name): SULIK SHERIDAN BRYAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 E 29TH ST
BRYAN TX
77802-1954
US

IV. Provider business mailing address

PO BOX 4045
BRYAN TX
77805-4045
US

V. Phone/Fax

Practice location:
  • Phone: 979-822-6611
  • Fax: 979-822-0462
Mailing address:
  • Phone: 979-846-4633
  • Fax: 979-846-7674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number101864
License Number StateTX

VIII. Authorized Official

Name: MS. LYNDA BEARD
Title or Position: CAO
Credential:
Phone: 979-846-4633