Provider Demographics
NPI:1538939830
Name:PERRY, SHERIDAN ORENE (BS)
Entity type:Individual
Prefix:
First Name:SHERIDAN
Middle Name:ORENE
Last Name:PERRY
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3507 W HIGHWAY 33
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-3166
Mailing Address - Country:US
Mailing Address - Phone:208-709-3392
Mailing Address - Fax:
Practice Address - Street 1:419 W MAIN ST APT 214
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-1468
Practice Address - Country:US
Practice Address - Phone:208-709-3392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician