Provider Demographics
NPI:1619719960
Name:SAM, SHERRY MATHEW
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:MATHEW
Last Name:SAM
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 1:18618 ROSLYN SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-1402
Mailing Address - Country:US
Mailing Address - Phone:832-353-7373
Mailing Address - Fax:281-206-4487
Practice Address - Street 1:6617 FM 2920 RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-2636
Practice Address - Country:US
Practice Address - Phone:346-220-3577
Practice Address - Fax:281-206-4487
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-08
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1165935363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty