Provider Demographics
NPI:1528179181
Name:SHERIDAN, CATHERINE (APN)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:SHERIDAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 WHITE PINE DRIVE
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080
Mailing Address - Country:US
Mailing Address - Phone:856-582-2298
Mailing Address - Fax:856-582-2298
Practice Address - Street 1:3288 DELSEA DR
Practice Address - Street 2:
Practice Address - City:FRANKLINVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08322-3165
Practice Address - Country:US
Practice Address - Phone:856-723-3941
Practice Address - Fax:856-582-2298
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO10537200163W00000X
NJ26NJ00076200364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0062464Medicaid
NJ089550Medicare ID - Type Unspecified
Q40130Medicare UPIN