Provider Demographics
NPI:1386131662
Name:SHERIDAN, RYAN (MSPO, CPO)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:SHERIDAN
Suffix:
Gender:M
Credentials:MSPO, CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32975 8 MILE RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1337
Mailing Address - Country:US
Mailing Address - Phone:248-615-0600
Mailing Address - Fax:
Practice Address - Street 1:32975 8 MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1337
Practice Address - Country:US
Practice Address - Phone:248-615-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-22
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICPO03718222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist