Provider Demographics
NPI:1992153951
Name:SHAEFER, SHERRY
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:SHAEFER
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 1:3333 COVINGTON CT
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77808-1412
Mailing Address - Country:US
Mailing Address - Phone:765-714-8476
Mailing Address - Fax:
Practice Address - Street 1:3333 COVINGTON CT
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77808-1412
Practice Address - Country:US
Practice Address - Phone:765-714-8476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC421504Medicaid
SC3335Medicare PIN