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General NPI Number Information
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NPI Number | 1194296236
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Entity Type | Individual
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Provider Name | SHIRILYN MONIQUE DYKES
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Gender | Female
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Dates
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Enumeration Date | 12/16/2018
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Last Update Date | 12/16/2018
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Provider Practice Location Address
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Address Line | 2063 CRENNAN LN STE C
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City | HEARNE
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State | TX
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Zip | 77859-2094
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Country | US
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Telephone | 979-814-0420
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Fax | 979-279-9492
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Provider Business Mailing Address
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Address Line | PO BOX 1011
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City | HEARNE
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State | TX
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Zip | 77859-1011
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Country | US
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Telephone | 979-814-0420
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number | 1002219
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License Number State | TX
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