Healthcare Provider Details

I. General information

NPI: 1780535476
Provider Name (Legal Business Name): TEESHA CHACKO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TEESHA CHACKO SHERIN NP

II. Dates (important events)

Enumeration Date: 02/07/2026
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 MEDICAL PKWY
CEDAR PARK TX
78613-7763
US

IV. Provider business mailing address

112 NETERLAND ST
GEORGETOWN TX
78628-2546
US

V. Phone/Fax

Practice location:
  • Phone: 832-917-3464
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1217922
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF357694
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: