Provider Demographics
NPI:1588309025
Name:KARSIS SHERIDAN, MICHELLE (CNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:KARSIS SHERIDAN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LYNNE
Other - Last Name:KARSIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21 OVERLOOK RIDGE TER UNIT 128
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-1194
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21 OVERLOOK RIDGE TER UNIT 128
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-1194
Practice Address - Country:US
Practice Address - Phone:781-388-0294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-29
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA236025163W00000X
MAPENDING363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Yes163W00000XNursing Service ProvidersRegistered Nurse