Provider Demographics
NPI:1821192006
Name:SHERIDAN, TARA MARIE THERESE (MD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:MARIE THERESE
Last Name:SHERIDAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:13352 GRANITE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-4072
Mailing Address - Country:US
Mailing Address - Phone:619-876-6463
Mailing Address - Fax:619-532-8945
Practice Address - Street 1:NAVAL MEDICAL CENTER SAN DIEGO
Practice Address - Street 2:34800 BOB WILSON DRIVE
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-5000
Practice Address - Country:US
Practice Address - Phone:619-532-8943
Practice Address - Fax:619-532-8945
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2023-12-19
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Provider Licenses
StateLicense IDTaxonomies
CAA94216207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine