Healthcare Provider Details

I. General information

NPI: 1053455253
Provider Name (Legal Business Name): SHARON COWAN-SHERIDAN MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5020 GODDARD AVE
ORLANDO FL
32804-1168
US

IV. Provider business mailing address

2976 HUNTERS LN
OVIEDO FL
32766-5072
US

V. Phone/Fax

Practice location:
  • Phone: 407-299-1533
  • Fax: 407-295-5965
Mailing address:
  • Phone: 407-365-1451
  • Fax: 407-295-5965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA3027
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: