Healthcare Provider Details

I. General information

NPI: 1548292402
Provider Name (Legal Business Name): ELLEN SUSAN SHER M.D., P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 FOREST LN SUITE B-303
DALLAS TX
75230-2505
US

IV. Provider business mailing address

7777 FOREST LN SUITE B-303
DALLAS TX
75230-2505
US

V. Phone/Fax

Practice location:
  • Phone: 972-566-8833
  • Fax: 972-566-8840
Mailing address:
  • Phone: 972-566-8833
  • Fax: 972-566-8840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberK5205
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: