Healthcare Provider Details

I. General information

NPI: 1871426841
Provider Name (Legal Business Name): SHERIDAN PSYCHOLOGY GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 SAINT ANDREWS RD
HOLLYWOOD FL
33021-2942
US

IV. Provider business mailing address

2007 SAINT ANDREWS RD
HOLLYWOOD FL
33021-2942
US

V. Phone/Fax

Practice location:
  • Phone: 786-390-4616
  • Fax:
Mailing address:
  • Phone: 786-390-4616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN GLUECK
Title or Position: MANAGING MEMBER
Credential: PHD
Phone: 786-390-4616