Provider Demographics
NPI:1104714229
Name:MAHAN, SHERIDON (LMT)
Entity type:Individual
Prefix:
First Name:SHERIDON
Middle Name:
Last Name:MAHAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2982 MEADOW VIEW AVE APT A
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-2559
Mailing Address - Country:US
Mailing Address - Phone:904-370-9347
Mailing Address - Fax:
Practice Address - Street 1:2982 MEADOW VIEW AVE APT A
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-2559
Practice Address - Country:US
Practice Address - Phone:904-370-9347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA104555225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty