Healthcare Provider Details

I. General information

NPI: 1336114222
Provider Name (Legal Business Name): SHERIDAN WEAR CULVAHOUSE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 W PUTNAM AVE
GREENWICH CT
06830-5329
US

IV. Provider business mailing address

23 MAHER AVE
GREENWICH CT
06830-5616
US

V. Phone/Fax

Practice location:
  • Phone: 203-869-7080
  • Fax: 203-869-7034
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number027129
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number208181-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: