Provider Demographics
NPI:1306354410
Name:FERNANDES, MERRYL JANE (DAOM, MAOM, NCCAOM)
Entity type:Individual
Prefix:DR
First Name:MERRYL
Middle Name:JANE
Last Name:FERNANDES
Suffix:
Gender:F
Credentials:DAOM, MAOM, NCCAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11206 STONEY MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-6613
Mailing Address - Country:US
Mailing Address - Phone:832-441-5823
Mailing Address - Fax:
Practice Address - Street 1:14555 SKINNER RD STE D2
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-4160
Practice Address - Country:US
Practice Address - Phone:183-441-5823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-11
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01429171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist