Provider Demographics
NPI:1982738258
Name:SHERIDAN, MONEE BYERS (LOTR)
Entity Type:Individual
Prefix:MRS
First Name:MONEE
Middle Name:BYERS
Last Name:SHERIDAN
Suffix:
Gender:F
Credentials:LOTR
Other - Prefix:MS
Other - First Name:MONEE
Other - Middle Name:ELIZABETH
Other - Last Name:BYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LOTR
Mailing Address - Street 1:PO BOX 2118
Mailing Address - Street 2:5640 HILLTOP CIRCLE
Mailing Address - City:SAINT FRANCISVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70775-2118
Mailing Address - Country:US
Mailing Address - Phone:985-351-2047
Mailing Address - Fax:
Practice Address - Street 1:5640 HILLTOP CIRCLE
Practice Address - Street 2:
Practice Address - City:SAINT FRANCISVILLE
Practice Address - State:LA
Practice Address - Zip Code:70775-2118
Practice Address - Country:US
Practice Address - Phone:985-351-2047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ11811174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1308668Medicaid