Provider Demographics
NPI:1679692123
Name:ACTON ROAD PEDIATRICS, LLC
Entity Type:Organization
Organization Name:ACTON ROAD PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN AND PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERIDYN
Authorized Official - Middle Name:B
Authorized Official - Last Name:BREEDLOVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-978-8245
Mailing Address - Street 1:2409 ACTON RD
Mailing Address - Street 2:SUITE 171
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-2940
Mailing Address - Country:US
Mailing Address - Phone:205-978-8245
Mailing Address - Fax:205-978-8249
Practice Address - Street 1:2409 ACTON RD
Practice Address - Street 2:SUITE 171
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-2940
Practice Address - Country:US
Practice Address - Phone:205-978-8245
Practice Address - Fax:205-978-8249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.18441208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC79105Medicare UPIN
ALG28054Medicare UPIN