Provider Demographics
NPI:1942492103
Name:SHERIDAN, JOSHUA M (PAC)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:M
Last Name:SHERIDAN
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 S PARK ST RM A404
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1830
Mailing Address - Country:US
Mailing Address - Phone:608-258-6504
Mailing Address - Fax:608-229-8588
Practice Address - Street 1:700 S PARK ST RM A404
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1830
Practice Address - Country:US
Practice Address - Phone:608-258-6504
Practice Address - Fax:608-229-8588
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1854 023207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine