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1619897113 NPI number — SHERIDAN BROOKE LARA EDS,MA,BA

NPI Number: 1619897113
Health Care Provider/Practitioner: SHERIDAN BROOKE LARA EDS,MA,BA

Information about “1619897113” NPI (SHERIDAN BROOKE LARA EDS,MA,BA) exists in 1619897113 in HTML format HTML  |  1619897113 in plain Text format TXT  |  1619897113 in PDF (Portable Document Format) PDF  |  1619897113 in an XML format XML  formats.

NPI Number : 1619897113 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1619897113",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LARA",
    "FirstName": "SHERIDAN",
    "MiddleName": "BROOKE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "EDS,MA,BA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "AVERY",
    "OtherFirstName": "SHERIDAN",
    "OtherMiddleName": "BROOKE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "2436 RIDGEWOOD CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "JEFFERSONVILLE",
    "MailingAddressStateName": "IN",
    "MailingAddressPostalCode": "47130-7578",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "812-670-6700",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2112 UTICA SELLERSBURG RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "JEFFERSONVILLE",
    "PracticeLocationAddressStateName": "IN",
    "PracticeLocationAddressPostalCode": "47130-8506",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "812-283-0701",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/16/2026",
    "LastUpdateDate": "07/16/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "103TS0200X",
        "TaxonomyName": "School Psychologist",
        "LicenseNumber": "000018004",
        "LicenseNumberStateCode": "IN",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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