Healthcare Provider Details

I. General information

NPI: 1710444872
Provider Name (Legal Business Name): ANDREW SHERIDAN CSFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2019
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15524 GOLDEN RIDGE CT
CHESTERFIELD MO
63017-5124
US

IV. Provider business mailing address

15524 GOLDEN RIDGE CT
CHESTERFIELD MO
63017-5124
US

V. Phone/Fax

Practice location:
  • Phone: 636-346-8182
  • Fax:
Mailing address:
  • Phone: 636-346-8182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: