Healthcare Provider Details

I. General information

NPI: 1427775451
Provider Name (Legal Business Name): FULL LIFE PRIMARY CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2022
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E TAYLOR ST STE 201
SHERMAN TX
75090-2832
US

IV. Provider business mailing address

600 E TAYLOR ST STE 201
SHERMAN TX
75090-2832
US

V. Phone/Fax

Practice location:
  • Phone: 903-257-3929
  • Fax: 903-827-4015
Mailing address:
  • Phone: 903-257-3929
  • Fax: 903-827-4015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SHEELU MATHEWS
Title or Position: MANAGER
Credential: MD
Phone: 973-207-4589