Provider Demographics
NPI:1689662728
Name:HERNANDEZ, SHERIDAN JANE (MD)
Entity Type:Individual
Prefix:
First Name:SHERIDAN
Middle Name:JANE
Last Name:HERNANDEZ
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 1:2044 TRINITY OAKS BLVD
Mailing Address - Street 2:SUITE 235
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-3908
Mailing Address - Country:US
Mailing Address - Phone:727-375-5437
Mailing Address - Fax:727-375-0502
Practice Address - Street 1:2044 TRINITY OAKS BLVD.
Practice Address - Street 2:SUITE 235
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-3908
Practice Address - Country:US
Practice Address - Phone:727-375-5437
Practice Address - Fax:727-375-0502
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME87707208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267020800Medicaid
FL267020800Medicaid