=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003937160
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHERI BREANNE O'LEARY PA-C, MPAS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2007
-----------------------------------------------------
Last Update Date | 12/27/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1155 PRESSLER ST DEPARTMENT OF BREAST MEDICAL ONCOLOGY- UNIT 1354
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77030-3721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-563-8984
-----------------------------------------------------
Fax | 713-563-0910
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1320 DIAN ST
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77008-3706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-703-0207
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | PA05159
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------