Provider Demographics
NPI:1114158573
Name:SHERIDAN-YOUNG, PATRICIA LORAINE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:LORAINE
Last Name:SHERIDAN-YOUNG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 NAISMITH DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66045-4069
Mailing Address - Country:US
Mailing Address - Phone:785-864-7417
Mailing Address - Fax:785-864-7483
Practice Address - Street 1:3211 S IOWA ST STE 100
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66046-5238
Practice Address - Country:US
Practice Address - Phone:785-505-5475
Practice Address - Fax:785-505-5326
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01439363A00000X
MN10620363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical