Healthcare Provider Details

I. General information

NPI: 1225861990
Provider Name (Legal Business Name): SHERIDAN WHALEN CLEAVE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2024
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6923 SHANNON WILLOW RD STE 100
CHARLOTTE NC
28226-1331
US

IV. Provider business mailing address

135 W MOREHEAD ST UNIT 150
CHARLOTTE NC
28202-2670
US

V. Phone/Fax

Practice location:
  • Phone: 704-774-1041
  • Fax:
Mailing address:
  • Phone: 312-505-2033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number17044
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: