Healthcare Provider Details

I. General information

NPI: 1720058712
Provider Name (Legal Business Name): KATHLEEN M SHERIDAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN SHERIDAN BELLIS

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 HIGHLANDS DR STE 101
LITITZ PA
17543-7507
US

IV. Provider business mailing address

1575 HIGHLANDS DR STE 101
LITITZ PA
17543-7507
US

V. Phone/Fax

Practice location:
  • Phone: 717-393-1338
  • Fax: 717-627-1817
Mailing address:
  • Phone: 717-393-1338
  • Fax: 717-627-1817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD19898
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number270045
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD428219
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: