Healthcare Provider Details

I. General information

NPI: 1952877383
Provider Name (Legal Business Name): SHERIDYN WILKINS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1582 N WAGGONER RD
BLACKLICK OH
43004-8669
US

IV. Provider business mailing address

300 INTERNATIONAL PKWY STE 2000
LAKE MARY FL
32746-5035
US

V. Phone/Fax

Practice location:
  • Phone: 614-344-0419
  • Fax:
Mailing address:
  • Phone: 866-610-0580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: