1952652539 NPI number — MRS. ALESIA MARIE SHERIDAN BCBA

Table of content: MRS. ALESIA MARIE SHERIDAN BCBA (NPI 1952652539)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952652539 NPI number — MRS. ALESIA MARIE SHERIDAN BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHERIDAN
Provider First Name:
ALESIA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BARRY
Provider Other First Name:
ALESIA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1952652539
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/16/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
45 R WASHINGTON ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORWELL
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02061-1715
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-923-0900
Provider Business Mailing Address Fax Number:
781-773-1326

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
45 R WASHINGTON ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORWELL
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02061-1715
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-923-0900
Provider Business Practice Location Address Fax Number:
781-773-1326
Provider Enumeration Date:
09/24/2012

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: 222Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103K00000X , with the licence number: 1-15-20148 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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