Provider Demographics
NPI:1093121949
Name:SHERIDAN, NATALIE (LMHC)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:SHERIDAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:
Other - Last Name:PAVONE SHERIDAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:5325 ROYAL PLANTATION BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-7566
Mailing Address - Country:US
Mailing Address - Phone:386-690-5601
Mailing Address - Fax:
Practice Address - Street 1:2400 S RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-3097
Practice Address - Country:US
Practice Address - Phone:386-295-9406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-10
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health