Provider Demographics
NPI:1316902745
Name:MICHELS, SHERY. DIANE (MD)
Entity type:Individual
Prefix:DR
First Name:SHERY.
Middle Name:DIANE
Last Name:MICHELS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHERYL
Other - Middle Name:MICHELS
Other - Last Name:ZEIFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9200 WALL ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-4534
Mailing Address - Country:US
Mailing Address - Phone:512-339-1275
Mailing Address - Fax:512-873-5069
Practice Address - Street 1:9200 WALL ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78754-4534
Practice Address - Country:US
Practice Address - Phone:512-339-1275
Practice Address - Fax:512-873-5069
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7191207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP080P9254Medicaid
TXE56706Medicare UPIN
TX80P925Medicare ID - Type Unspecified