MEDICARE: SHERIDAN HEALTHCORP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1518631902
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHERIDAN HEALTHCORP INC

Provider Business Mailing Address
First Line	:	5565 CENTERVIEW DR STE 107
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27606-3563
Country	:	US
Telephone Number	:	469-613-8343
Fax Number	:

Provider Business Practice Location Address
First Line	:	1465 KINGSLEY AVE STE 1401
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-4504
Country	:	US
Telephone Number	:	877-328-1119
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	KATHY KONDAS
Credential	:
Telephone Number	:	877-328-1119

Provider Enumeration Date	:	08/09/2021
Last Update Date	:	08/09/2021

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Directions to “SHERIDAN HEALTHCORP INC ” Practice Location

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