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General NPI Number Information
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NPI Number | 1134779325
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Entity Type | Individual
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Provider Name | LAURA ELIZABETH SHERIDAN PA
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Gender | Female
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Dates
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Enumeration Date | 09/19/2019
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 970 HOOPER AVE
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City | TOMS RIVER
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State | NJ
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Zip | 08753-8319
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Country | US
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Telephone | 732-228-4146
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Fax | 732-504-7104
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Provider Business Mailing Address
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Address Line | 1 DIAMOND HILL RD
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City | BERKELEY HEIGHTS
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State | NJ
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Zip | 07922-2104
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Country | US
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Telephone | 908-273-4300
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 25MP00877600
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License Number State | NJ
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