Provider Demographics
NPI:1891384228
Name:SHERIDAN, LAURENCE JOSEPH (NP)
Entity Type:Individual
Prefix:
First Name:LAURENCE
Middle Name:JOSEPH
Last Name:SHERIDAN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 WASHINGTON ST APT 1414
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-4908
Mailing Address - Country:US
Mailing Address - Phone:610-306-7666
Mailing Address - Fax:
Practice Address - Street 1:717 BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:GLENSIDE
Practice Address - State:PA
Practice Address - Zip Code:19038-8111
Practice Address - Country:US
Practice Address - Phone:610-306-7666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022768363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health