Healthcare Provider Details

I. General information

NPI: 1578916516
Provider Name (Legal Business Name): PHILIP HENRY SHERIDAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2016
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FDA BUILDING 22 RM 4372 10903 NEW HAMPSHIRE AVENUE
SILVER SPRING MD
20993-0002
US

IV. Provider business mailing address

FDA BUILDING 22 RM 4372 10903 NEW HAMPSHIRE AVENUE
SILVER SPRING MD
20993-0002
US

V. Phone/Fax

Practice location:
  • Phone: 301-796-1145
  • Fax: 301-796-9842
Mailing address:
  • Phone: 301-796-1145
  • Fax: 301-796-9842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101034855
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number0101034855
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: