Healthcare Provider Details

I. General information

NPI: 1154379642
Provider Name (Legal Business Name): DONALD CHARLES SHERIDAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 11/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10213 N 92ND ST SUITE 101
SCOTTSDALE AZ
85258-4561
US

IV. Provider business mailing address

10213 N 92ND ST SUITE 101
SCOTTSDALE AZ
85258-4561
US

V. Phone/Fax

Practice location:
  • Phone: 480-860-6005
  • Fax: 480-860-1882
Mailing address:
  • Phone: 480-860-6005
  • Fax: 480-860-1882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number24106
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number24106
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: