Provider Demographics
NPI:1396322988
Name:SHERIDAN, BRIANNA (MD)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:SHERIDAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:
Other - Last Name:BAHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1711 D STREET
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76127
Mailing Address - Country:US
Mailing Address - Phone:817-782-5900
Mailing Address - Fax:
Practice Address - Street 1:1711 D STREET
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76127
Practice Address - Country:US
Practice Address - Phone:817-782-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-28
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171000000X, 390200000X
VA01012760782083A0100X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No171000000XOther Service ProvidersMilitary Health Care Provider
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program