Healthcare Provider Details

I. General information

NPI: 1568716454
Provider Name (Legal Business Name): DAVID WILLIAM SHERIDAN NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2012
Last Update Date: 07/10/2020
Certification Date: 07/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 GOVERNORS DR SW FL 1
HUNTSVILLE AL
35801-5171
US

IV. Provider business mailing address

191 TERRY DRAKE RD SE
OWENS CROSS ROADS AL
35763-5704
US

V. Phone/Fax

Practice location:
  • Phone: 562-533-1600
  • Fax: 256-539-0856
Mailing address:
  • Phone: 520-390-1780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number847811
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number847811
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP4733
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP124560
License Number StateTX
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-171804
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: