Provider Demographics
NPI:1821852740
Name:SHERIDAN, SHEBRETTA (CPI)
Entity Type:Individual
Prefix:
First Name:SHEBRETTA
Middle Name:
Last Name:SHERIDAN
Suffix:
Gender:F
Credentials:CPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 SILVERTHORNE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-3434
Mailing Address - Country:US
Mailing Address - Phone:443-286-2519
Mailing Address - Fax:
Practice Address - Street 1:1223 SILVERTHORNE RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-3434
Practice Address - Country:US
Practice Address - Phone:443-286-2519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy