Provider Demographics
NPI:1780801852
Name:SHERIDAN, KEEGAN FORD (ND)
Entity type:Individual
Prefix:DR
First Name:KEEGAN
Middle Name:FORD
Last Name:SHERIDAN
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 S SYCAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-2835
Mailing Address - Country:US
Mailing Address - Phone:310-270-7918
Mailing Address - Fax:310-231-3570
Practice Address - Street 1:2001 S BARRINGTON AVE
Practice Address - Street 2:SUITE 116
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5363
Practice Address - Country:US
Practice Address - Phone:310-270-7918
Practice Address - Fax:310-231-3570
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA-56175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath