MEDICARE: KATY SHERIDAN MD PC

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	207Q00000X	Family Medicine Physician	3723	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992814818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KATY SHERIDAN MD PC

Provider Business Mailing Address
First Line	:	154 W MARYDALE AVE
Second Line	:
City	:	SOLDOTNA
State	:	AK
Zip	:	99669-7501
Country	:	US
Telephone Number	:	907-260-3121
Fax Number	:	907-260-4022

Provider Business Practice Location Address
First Line	:	154 W MARYDALE AVE
Second Line	:
City	:	SOLDOTNA
State	:	AK
Zip	:	99669-7501
Country	:	US
Telephone Number	:	907-260-3121
Fax Number	:	907-260-4022

Authorized Official
Title or Position	:	OWNER
Name	:	KATY MARIE SHERIDAN
Credential	:	M.D.
Telephone Number	:	907-260-3121

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	08/30/2016

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