Provider Demographics
NPI:1952398760
Name:SHERIDAN, PAMELA J (DPM)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:J
Last Name:SHERIDAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750 W ALEXIS RD
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2349
Mailing Address - Country:US
Mailing Address - Phone:419-824-0300
Mailing Address - Fax:419-824-0500
Practice Address - Street 1:5750 W ALEXIS RD
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2349
Practice Address - Country:US
Practice Address - Phone:419-824-0300
Practice Address - Fax:419-824-0500
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002275213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0586763Medicaid
OHSH0566753Medicare ID - Type Unspecified
T63325Medicare UPIN