Provider Demographics
NPI:1013363019
Name:SHERIDAN, PATRICK L
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:L
Last Name:SHERIDAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 N WEBB RD
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4045
Mailing Address - Country:US
Mailing Address - Phone:308-384-9300
Mailing Address - Fax:
Practice Address - Street 1:418 N WEBB RD
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4045
Practice Address - Country:US
Practice Address - Phone:308-384-9300
Practice Address - Fax:308-384-4542
Is Sole Proprietor?:No
Enumeration Date:2016-05-09
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE782237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist