1841324571 NPI number — MRS. CANDICE SWEET SHERIDAN OTRL

Table of content: MRS. CANDICE SWEET SHERIDAN OTRL (NPI 1841324571)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841324571 NPI number — MRS. CANDICE SWEET SHERIDAN OTRL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHERIDAN
Provider First Name:
CANDICE
Provider Middle Name:
SWEET
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTRL
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841324571
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 806
Provider Second Line Business Mailing Address:
1845 LIGHTHOUSE RD
Provider Business Mailing Address City Name:
CARRABELLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32322-0806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-697-8640
Provider Business Mailing Address Fax Number:
850-697-8640

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1845 LIGHTHOUSE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARRABELLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-567-7270
Provider Business Practice Location Address Fax Number:
850-697-8640
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  OT9771 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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