Provider Demographics
NPI:1922132612
Name:ROWLETTE SHERIDAN, ANN MARIE
Entity Type:Individual
Prefix:MRS
First Name:ANN MARIE
Middle Name:
Last Name:ROWLETTE SHERIDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ANN MARIE
Other - Middle Name:
Other - Last Name:SHERIDAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:401 DIXON RD
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-4149
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 DIXON RD
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-4149
Practice Address - Country:US
Practice Address - Phone:845-228-2984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219332164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01652299Medicaid