Provider Demographics
NPI:1962799833
Name:TRINITY SHERADEN
Entity type:Organization
Organization Name:TRINITY SHERADEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRINITY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERADEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:503-869-7380
Mailing Address - Street 1:2263 NE CORNELL RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-5947
Mailing Address - Country:US
Mailing Address - Phone:503-869-7380
Mailing Address - Fax:866-548-6743
Practice Address - Street 1:1085 MONEDA AVE N
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-6256
Practice Address - Country:US
Practice Address - Phone:503-869-7380
Practice Address - Fax:866-548-6743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-29
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1073682019OtherNPI-TRINITY SHERADEN
TS1037297OtherAMERICAN SPECIALTY HEALTH NETWORK
7300OtherOREGON MASSAGE BOARD