Basic Information
| Provider Information | |||||||||
| NPI: | 1568716454 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHERIDAN | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | WILLIAM | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 191 TERRY DRAKE RD SE | ||||||||
| Address2: | |||||||||
| City: | OWENS CROSS ROADS | ||||||||
| State: | AL | ||||||||
| PostalCode: | 357635704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203901780 | ||||||||
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| Practice Location | |||||||||
| Address1: | 201 GOVERNORS DR SW FL 1 | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358015171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5625331600 | ||||||||
| FaxNumber: | 2565390856 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2012 | ||||||||
| LastUpdateDate: | 07/10/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 847811 | TX | N | Nursing Service Providers | Registered Nurse | 163WR0006X | 847811 | TX | N | Nursing Service Providers | Registered Nurse | Registered Nurse First Assistant | 363LF0000X | AP4733 | AZ | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | AP124560 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 1-171804 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.