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General NPI Number Information
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NPI Number | 1710988936
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Entity Type | Individual
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Provider Name | EDWARD J SHERIDAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/10/2005
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Last Update Date | 07/15/2009
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Provider Practice Location Address
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Address Line | 159 E 2ND ST
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City | CHILLICOTHEE
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State | OH
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Zip | 45601-2526
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Country | US
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Telephone | 740-773-6347
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Fax | 740-773-9093
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Provider Business Mailing Address
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Address Line | 1456 JACKSON PIKE STE 2
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City | GALLIPOLIS
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State | OH
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Zip | 45631-2602
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Country | US
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Telephone | 740-446-0112
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Fax | 740-446-4732
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 35038030S
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 11622
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License Number State | WV
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 4301060933
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License Number State | MI
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