Mallory Jane Sheridan, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601010628 Issued in MI

Practice address

16826 Newburgh Rd
Livonia, MI 48154-1600

Phone

(734) 464-8400

Fax

(734) 464-9515

NPI assigned

Jun 25, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Wayne State University School of Medicine, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advanced Dermatology of Michigan PCGroup PAC ID 0941511224, 40 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

84.2 of 100Reported as group

Quality

81.43

Promoting interoperability

82

Improvement activities

40

Cost

80.91

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Advanced Dermatology of Michigan PC

  • Dermatology Physician
  • Wyandotte, MI
  • NPI 1851708929
  Medicare reassignment Care Compare group
• Kalamazoo Dermatology, P.C.

  • Dermatology Physician
  • Portage, MI
  • NPI 1073607925
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1624579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748390400000",
    "number": "1245800937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3021 BIRCH ROW DR APT 14",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488232295",
            "telephone_number": "231-675-7250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16826 NEWBURGH RD",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "481541600",
            "telephone_number": "734-464-8400",
            "fax_number": "734-464-9515"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "416 S Creyts Rd",
            "address_purpose": "LOCATION",
            "city": "Lansing",
            "state": "MI",
            "postal_code": "489178290",
            "country_code": "US",
            "telephone_number": "517-886-0333",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHERIDAN",
        "first_name": "MALLORY",
        "middle_name": "JANE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-25",
        "last_updated": "2025-05-28",
        "certification_date": "2025-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601010628",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jordyn Nicole Shepler, PT, DPT
• Kristin Sheppard
• Adrian Sheremeta, M.D.
• Christine Ruth Sheremeta
• Rebecca Ann Sheren, BEHAVIOR TECHNICIAN
• Ryan Sheridan, MSPO, CPO
• Hannah Elizabeth Sherman
• Paul Andrew Sherman
• Rebecca L Sherman, LMSW
• Serena M Sherry, PA-C

• Physician Assistant in Livonia, MI
• Providers in Livonia, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.