Provider Demographics
NPI:1811492226
Name:ECKART-BUDINICH, SHERIDAN LEE (DO)
Entity type:Individual
Prefix:
First Name:SHERIDAN
Middle Name:LEE
Last Name:ECKART-BUDINICH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 TAHOMA BLVD UNIT 102
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-7735
Mailing Address - Country:US
Mailing Address - Phone:360-458-8115
Mailing Address - Fax:360-458-8316
Practice Address - Street 1:201 TAHOMA BLVD
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-7735
Practice Address - Country:US
Practice Address - Phone:406-853-2502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP61422681207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine