Healthcare Provider Details

I. General information

NPI: 1396322988
Provider Name (Legal Business Name): BRIANNA SHERIDAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRIANNA BAHE MD

II. Dates (important events)

Enumeration Date: 03/28/2021
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 860912
MINNEAPOLIS MN
55486-0912
US

IV. Provider business mailing address

1711 D STREET
FORT WORTH TX
76127
US

V. Phone/Fax

Practice location:
  • Phone: 507-284-2511
  • Fax: 507-284-0702
Mailing address:
  • Phone: 817-782-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number0101276078
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number82441
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101276078
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: