Provider Demographics
NPI:1902909476
Name:SHERIDAN, MICHAEL M (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:M
Last Name:SHERIDAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4988 STATE HIGHWAY 30
Mailing Address - Street 2:AMSTERDAM MEMORIAL HEALTH CENTER
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-7520
Mailing Address - Country:US
Mailing Address - Phone:518-843-5793
Mailing Address - Fax:518-843-6513
Practice Address - Street 1:4988 STATE HIGHWAY 30
Practice Address - Street 2:AMSTERDAM MEMORIAL HEALTH CENTER
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-7520
Practice Address - Country:US
Practice Address - Phone:518-843-5793
Practice Address - Fax:518-843-6513
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY165622207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
08230OtherMUP
NY01170667Medicaid
000401398001OtherDSNENY
10001883OtherCDPHP
547811OtherBLUE CHOICE
08230OtherMUP
E23639Medicare UPIN