Provider Demographics
NPI:1033300686
Name:COMEAUX, DANIELLE SHERRELLE (PA)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:SHERRELLE
Last Name:COMEAUX
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18220 TOMBALL PKWY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-4347
Mailing Address - Country:US
Mailing Address - Phone:281-737-0999
Mailing Address - Fax:281-737-0926
Practice Address - Street 1:18220 TOMBALL PKWY
Practice Address - Street 2:SUITE 400
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4347
Practice Address - Country:US
Practice Address - Phone:281-737-0999
Practice Address - Fax:281-737-0926
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05270363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX305772101Medicaid
601771109OtherUS DEPT OF LABOR
616771110OtherUS DEPT OF LABOR
TXP01086516OtherRR MEDICARE
TX8366NDOtherBLUE CROSS BLUE SHIELD
TXP01289664OtherRR MEDICARE
TX305772103Medicaid
616771105OtherUS DEPT OF LABOR
TX1033300686OtherBLUE CROSS BLUE SHIELD
616771101OtherUS DEPT OF LABOR
TX827N74OtherBLUE CROSS BLUE SHIELD
TX305772101Medicaid
TX502827ZSWDMedicare PIN
601771109OtherUS DEPT OF LABOR
TX393952YMVQMedicare PIN