Provider Demographics
NPI:1225861990
Name:CLEAVE, SHERIDAN WHALEN
Entity type:Individual
Prefix:
First Name:SHERIDAN
Middle Name:WHALEN
Last Name:CLEAVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10731 SURREY GREEN LN
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-8972
Mailing Address - Country:US
Mailing Address - Phone:312-505-2033
Mailing Address - Fax:
Practice Address - Street 1:1315 E SUNSET DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-4324
Practice Address - Country:US
Practice Address - Phone:704-774-1041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
17044225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty