Provider Demographics
NPI:1851561997
Name:SHERIDAN LYNN KOPLOW ED D PA
Entity Type:Organization
Organization Name:SHERIDAN LYNN KOPLOW ED D PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHERIDAN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KOPLOW
Authorized Official - Suffix:
Authorized Official - Credentials:ED D
Authorized Official - Phone:561-784-7767
Mailing Address - Street 1:10111 W FOREST HILL BLVD
Mailing Address - Street 2:SUITE 369
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6108
Mailing Address - Country:US
Mailing Address - Phone:561-785-7767
Mailing Address - Fax:561-784-4626
Practice Address - Street 1:10111 W FOREST HILL BLVD
Practice Address - Street 2:SUITE 369
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6108
Practice Address - Country:US
Practice Address - Phone:561-785-7767
Practice Address - Fax:561-784-4626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6678103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73130AMedicare PIN