Provider Demographics
NPI:1053455253
Name:COWAN-SHERIDAN, SHARON (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:
Last Name:COWAN-SHERIDAN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2976 HUNTERS LN
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32766-5072
Mailing Address - Country:US
Mailing Address - Phone:407-365-1451
Mailing Address - Fax:407-295-5965
Practice Address - Street 1:5020 GODDARD AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-1168
Practice Address - Country:US
Practice Address - Phone:407-299-1533
Practice Address - Fax:407-295-5965
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA3027235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88235700Medicaid