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General NPI Number Information
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NPI Number | 1376403022
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Entity Type | Individual
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Provider Name | SHERIDAN VANDIVER RBT
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Gender |
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Dates
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Enumeration Date | 11/14/2025
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Last Update Date | 11/14/2025
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Provider Practice Location Address
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Address Line | 120 BROADUS AVE STE 100
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City | GREENVILLE
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State | SC
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Zip | 29601-3040
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Country | US
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Telephone | 803-335-0718
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Fax |
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Provider Business Mailing Address
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Address Line | 16255 VENTURA BLVD STE 900
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City | ENCINO
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State | CA
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Zip | 91436-2317
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Country | US
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Telephone |
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-25-490887
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License Number State |
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