Healthcare Provider Details

I. General information

NPI: 1962321430
Provider Name (Legal Business Name): SHERIDAN WOODS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 VETERANS PKWY STE 11
COLUMBUS GA
31909-3514
US

IV. Provider business mailing address

1202 TECH BLVD STE 104
TAMPA FL
33619-7863
US

V. Phone/Fax

Practice location:
  • Phone: 813-336-6413
  • Fax:
Mailing address:
  • Phone: 813-438-6796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-393997
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: