Provider Demographics
NPI:1164537767
Name:SHERIDAN, LYNDA A (DPM)
Entity Type:Individual
Prefix:DR
First Name:LYNDA
Middle Name:A
Last Name:SHERIDAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3-19 17TH STREET
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410
Mailing Address - Country:US
Mailing Address - Phone:201-797-7351
Mailing Address - Fax:973-773-9216
Practice Address - Street 1:1033 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013
Practice Address - Country:US
Practice Address - Phone:973-473-3344
Practice Address - Fax:973-473-8389
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00192600213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1109901Medicaid
NJSH577850Medicare ID - Type Unspecified
NJ1109901Medicaid