Provider Demographics
NPI:1588619555
Name:SHERIDAN, DIANE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:MARIE
Last Name:SHERIDAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 10TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MINDEN
Mailing Address - State:NV
Mailing Address - Zip Code:89423-4413
Mailing Address - Country:US
Mailing Address - Phone:775-782-0700
Mailing Address - Fax:775-782-0500
Practice Address - Street 1:1624 10TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423-4413
Practice Address - Country:US
Practice Address - Phone:775-782-0700
Practice Address - Fax:775-782-0500
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7773207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
BX462AOtherMEDICARE PTAN
1841429263OtherGROUP NPI
NV41490OtherBCBS NUMBER
NV2003010Medicaid
1841429263OtherGROUP NPI