Provider Demographics
NPI:1164025516
Name:SHERIDAN, ROBIN LYNN
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:LYNN
Last Name:SHERIDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4616 PARKLAWN DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45440-1914
Mailing Address - Country:US
Mailing Address - Phone:937-371-5155
Mailing Address - Fax:
Practice Address - Street 1:4616 PARKLAWN DR
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45440-1914
Practice Address - Country:US
Practice Address - Phone:937-371-1555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRG432392374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide