Provider Demographics
NPI:1154876399
Name:SHERIDAN, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:SHERIDAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 IRVING RD
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-4029
Mailing Address - Country:US
Mailing Address - Phone:516-356-7584
Mailing Address - Fax:
Practice Address - Street 1:125 W SHORE RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2042
Practice Address - Country:US
Practice Address - Phone:631-944-3134
Practice Address - Fax:631-944-3136
Is Sole Proprietor?:No
Enumeration Date:2016-08-17
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04129201225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist