Healthcare Provider Details

I. General information

NPI: 1386741296
Provider Name (Legal Business Name): PETER J SHERIDAN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/14/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 AMBRIAR PLAZA
AMHERST VA
24521
US

IV. Provider business mailing address

PO BOX 45923
BALTIMORE MD
21297-5923
US

V. Phone/Fax

Practice location:
  • Phone: 434-385-5600
  • Fax:
Mailing address:
  • Phone: 434-385-5600
  • Fax: 434-455-7172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618002530
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG001726
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: