Provider Demographics
NPI:1134353717
Name:SHERIDAN
Entity type:Organization
Organization Name:SHERIDAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNA
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINA
Authorized Official - Middle Name:PAULA
Authorized Official - Last Name:BELISLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-233-8247
Mailing Address - Street 1:9970 SW 156TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1643
Mailing Address - Country:US
Mailing Address - Phone:305-233-8247
Mailing Address - Fax:
Practice Address - Street 1:9970 SW 156TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-1643
Practice Address - Country:US
Practice Address - Phone:305-233-8247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9203446314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility