MEDICARE: MRS. MADISON DREW SHERIDAN FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	354425	NY

General Provider Information

NPI Number	:	1700614526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MADISON DREW SHERIDAN FNP-C

Provider Business Mailing Address
First Line	:	4040 JORDAN RD
Second Line	:
City	:	SKANEATELES
State	:	NY
Zip	:	13152-9440
Country	:	US
Telephone Number	:	315-406-9099
Fax Number	:

Provider Business Practice Location Address
First Line	:	6810 E GENESEE ST
Second Line	:
City	:	FAYETTEVILLE
State	:	NY
Zip	:	13066-1011
Country	:	US
Telephone Number	:	315-362-5074
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2024
Last Update Date	:	05/04/2026

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