Provider Demographics
NPI:1679554661
Name:SHERIDAN, VALERIE L (DO)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:L
Last Name:SHERIDAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51058
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85208-0053
Mailing Address - Country:US
Mailing Address - Phone:480-354-7478
Mailing Address - Fax:480-354-7480
Practice Address - Street 1:3035 S ELLSWORTH RD
Practice Address - Street 2:SUITE 104
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212
Practice Address - Country:US
Practice Address - Phone:480-354-7478
Practice Address - Fax:480-354-7480
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3977208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0743390OtherBCBS
AZ832065Medicaid
G30476Medicare UPIN
AZ832065Medicaid