Provider Demographics
NPI:1154420768
Name:SHERIDAN FAMILY PRACTICE, P.C.
Entity type:Organization
Organization Name:SHERIDAN FAMILY PRACTICE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:307-672-0763
Mailing Address - Street 1:1435 BURTON ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-2723
Mailing Address - Country:US
Mailing Address - Phone:307-672-0763
Mailing Address - Fax:307-672-0766
Practice Address - Street 1:1435 BURTON ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-2723
Practice Address - Country:US
Practice Address - Phone:307-672-0763
Practice Address - Fax:307-672-0766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY4286A207Q00000X
WY15246.316363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY305501OtherBCBS
WY313086OtherBCBS
WY1201867001Medicaid
WY305501OtherBCBS
WY9790Medicare ID - Type Unspecified
WY313086OtherBCBS