Provider Demographics
NPI:1801876636
Name:WILLIS, SHERYL L (MD)
Entity type:Individual
Prefix:DR
First Name:SHERYL
Middle Name:L
Last Name:WILLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14275 MIDWAY RD
Mailing Address - Street 2:400
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3614
Mailing Address - Country:US
Mailing Address - Phone:214-932-8255
Mailing Address - Fax:972-383-2839
Practice Address - Street 1:401 W CAMPBELL RD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3416
Practice Address - Country:US
Practice Address - Phone:972-498-4724
Practice Address - Fax:972-498-4836
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5516207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX129407606Medicaid
TX129407607Medicaid
TX129407608Medicaid
TX80768JMedicare ID - Type Unspecified
TX8A4168Medicare ID - Type Unspecified
TX129407608Medicaid
TX8B9848Medicare PIN
TX8B1903Medicare ID - Type Unspecified