Provider Demographics
NPI:1760020986
Name:SHERIDAN, KING H (MSPSYED, CRA)
Entity Type:Individual
Prefix:MR
First Name:KING
Middle Name:H
Last Name:SHERIDAN
Suffix:
Gender:M
Credentials:MSPSYED, CRA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-3004
Mailing Address - Country:US
Mailing Address - Phone:201-385-4400
Mailing Address - Fax:201-385-9689
Practice Address - Street 1:2 PARK AVE
Practice Address - Street 2:
Practice Address - City:DUMONT
Practice Address - State:NJ
Practice Address - Zip Code:07628-3004
Practice Address - Country:US
Practice Address - Phone:201-385-4400
Practice Address - Fax:201-385-9689
Is Sole Proprietor?:No
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health