Provider Demographics
NPI:1770205650
Name:BRIDDELL, SHERIDAN (PA-C)
Entity type:Individual
Prefix:
First Name:SHERIDAN
Middle Name:
Last Name:BRIDDELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHERIDAN
Other - Middle Name:
Other - Last Name:PALUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6700 PERIMETER DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-3505
Mailing Address - Country:US
Mailing Address - Phone:614-566-0074
Mailing Address - Fax:
Practice Address - Street 1:6700 PERIMETER DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-3505
Practice Address - Country:US
Practice Address - Phone:614-566-0074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-16
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.008725RX363A00000X
MI5601011400363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant