MEDICARE: SHEILA CARBALLO SY MSN, CPNP-AC

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	363LA2100X	Acute Care Nurse Practitioner	AP142590	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912569054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEILA CARBALLO SY MSN, CPNP-AC

Provider Business Mailing Address
First Line	:	3810 LAW ST APT 456
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-1277
Country	:	US
Telephone Number	:	917-346-6697
Fax Number	:

Provider Business Practice Location Address
First Line	:	6431 FANNIN STREET
Second Line	:	MSB 5.232
City	:	HOUSTON
State	:	TX
Zip	:	77003
Country	:	US
Telephone Number	:	713-500-7174
Fax Number	:	713-500-7296

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

Provider Enumeration Date	:	06/28/2019
Last Update Date	:	02/05/2026

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