Provider Demographics
NPI:1528290160
Name:SHERIDAN, JULIE LYNN (OTR, CHT)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:LYNN
Last Name:SHERIDAN
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7581 W HIGHWAY 98
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506-5939
Mailing Address - Country:US
Mailing Address - Phone:850-453-9673
Mailing Address - Fax:
Practice Address - Street 1:7581 W HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32506-5939
Practice Address - Country:US
Practice Address - Phone:850-453-9673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14066174400000X
NE408174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist