Provider Demographics
NPI:1932913241
Name:PETTUS, SHERAH
Entity type:Individual
Prefix:
First Name:SHERAH
Middle Name:
Last Name:PETTUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21872 MAIDENS CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-7706
Mailing Address - Country:US
Mailing Address - Phone:432-271-4998
Mailing Address - Fax:
Practice Address - Street 1:21872 MAIDENS CROSSING DR
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-7706
Practice Address - Country:US
Practice Address - Phone:432-271-4998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program