Provider Demographics
NPI:1750433231
Name:SHERIDAN, JAMEELAH DORHOSTI (LMP HHP)
Entity type:Individual
Prefix:MS
First Name:JAMEELAH
Middle Name:DORHOSTI
Last Name:SHERIDAN
Suffix:
Gender:F
Credentials:LMP HHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 S 240TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-3892
Mailing Address - Country:US
Mailing Address - Phone:206-200-0061
Mailing Address - Fax:206-212-7637
Practice Address - Street 1:550 S 240TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-3892
Practice Address - Country:US
Practice Address - Phone:206-200-0061
Practice Address - Fax:206-212-7637
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA0021446225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist