Healthcare Provider Details

I. General information

NPI: 1932795903
Provider Name (Legal Business Name): SEAN SHERIDAN APN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2020
Last Update Date: 12/14/2020
Certification Date: 12/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

641 ROUTE 18
EAST BRUNSWICK NJ
08816-3721
US

IV. Provider business mailing address

641 ROUTE 18
EAST BRUNSWICK NJ
08816-3721
US

V. Phone/Fax

Practice location:
  • Phone: 732-422-4889
  • Fax:
Mailing address:
  • Phone: 732-422-4889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ01090300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: