MEDICARE: SHARYN KAY HARRIS P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA00262	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	868N76	OTHER	TX	BLUE CROSS

General Provider Information

NPI Number	:	1285727339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARYN KAY HARRIS P.A.

Provider Business Mailing Address
First Line	:	1908 N LAURENT ST
Second Line	:	STE 370
City	:	VICTORIA
State	:	TX
Zip	:	77901-5468
Country	:	US
Telephone Number	:	361-572-0333
Fax Number	:	361-572-8518

Provider Business Practice Location Address
First Line	:	14100 RANCH ROAD 12
Second Line	:	STE 900
City	:	WIMBERLEY
State	:	TX
Zip	:	78676-5354
Country	:	US
Telephone Number	:	512-847-0300
Fax Number	:	512-847-0200

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	09/28/2012

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