Provider Demographics
NPI:1841429263
Name:DM SHERIDAN PLLC
Entity Type:Organization
Organization Name:DM SHERIDAN PLLC
Other - Org Name:MINDEN DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ SOLE MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHERIDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-782-0700
Mailing Address - Street 1:1624 10TH STREET
Mailing Address - Street 2:SUITE #1
Mailing Address - City:MINDEN
Mailing Address - State:NV
Mailing Address - Zip Code:89423-4477
Mailing Address - Country:US
Mailing Address - Phone:775-782-0700
Mailing Address - Fax:775-782-0500
Practice Address - Street 1:1624 10TH ST
Practice Address - Street 2:SUITE #1
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423-4481
Practice Address - Country:US
Practice Address - Phone:775-782-0700
Practice Address - Fax:775-782-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-07
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7773207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV31897Medicare PIN