Active NPI
Sheridan Long
- Massage Therapist
- Portland, OR
National Provider Identifier
1558731620
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 8047
- Practice address
- 6429 NE 33Rd Ave
Portland, OR 97211-7209 - Phone
- (503) 939-5520
- NPI assigned
- Oct 1, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 8047 | OR | Primary |
Addresses
Primary practice location
6429 NE 33Rd Ave
Portland, OR 97211-7209
Mailing address
6429 NE 33Rd Ave
Portland, OR 97211-7209
Phone (503) 939-5520
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8047 | OR | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1443657600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1443657600000",
"number": "1558731620",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6429 NE 33RD AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972117209",
"telephone_number": "503-939-5520"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6429 NE 33RD AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972117209",
"telephone_number": "503-939-5520"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LONG",
"first_name": "SHERIDAN",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-10-01",
"last_updated": "2015-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "OR",
"license": "8047",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.