Provider Demographics
NPI:1154379642
Name:SHERIDAN, DONALD CHARLES (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:CHARLES
Last Name:SHERIDAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10213 N 92ND ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4561
Mailing Address - Country:US
Mailing Address - Phone:480-860-6005
Mailing Address - Fax:480-860-1882
Practice Address - Street 1:10213 N 92ND ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4561
Practice Address - Country:US
Practice Address - Phone:480-860-6005
Practice Address - Fax:480-860-1882
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24106174400000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ00514071OtherINTERGROUP
AZ34408604OtherAHCCCS
200034022OtherRAILROAD MEDICARE
AZAZ0831310OtherBLUE CROSS BLUE SHIELD
AZ2032674OtherAETNA
AZ24479OtherMEDICARE PTAN
AZ34408604OtherAHCCCS