Provider Demographics
NPI:1134172745
Name:SHERIDAN, K M (MD)
Entity type:Individual
Prefix:
First Name:K M
Middle Name:
Last Name:SHERIDAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4051 BARRANCAS AVE
Mailing Address - Street 2:SUITE G#153
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507
Mailing Address - Country:US
Mailing Address - Phone:850-456-8811
Mailing Address - Fax:
Practice Address - Street 1:4555 LILLIAN HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32506-6435
Practice Address - Country:US
Practice Address - Phone:850-456-8811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62441208VP0000X
GA36001208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine