MEDICARE: MATTHEW SHERIDAN

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	101Y00000X	Counselor	MH21863	FL

General Provider Information

NPI Number	:	1649973116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW SHERIDAN

Provider Business Mailing Address
First Line	:	2120 HERSCHEL ST APT A
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-3879
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12443 SAN JOSE BLVD STE 604
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-8652
Country	:	US
Telephone Number	:	904-944-4625
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2023
Last Update Date	:	01/25/2024

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Directions to “ MATTHEW SHERIDAN ” Practice Location

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