Active NPI
Mary Sheridan, NNP
- Neonatal Nurse Practitioner
- Charleston, WV
National Provider Identifier
1790741775
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neonatal Nurse Practitioner
- License
- 43685
- Practice address
- 830 Pennsylvania Ave
Suite 406
Charleston, WV 25302-3302 - Phone
- (304) 388-2238
- Fax
- (304) 388-2618
- NPI assigned
- Apr 26, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Neonatal Nurse Practitioner | 363LN0000X | 43685 | WV | Primary |
Addresses
Primary practice location
830 Pennsylvania Ave
Suite 406
Charleston, WV 25302-3302
Mailing address
105 Deming Dr
Charleston, WV 25314-1013
Phone (304) 388-2238
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 |
|---|---|---|---|
| 43685 | WV | MD | Neonatal Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146009600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1217289600000",
"number": "1790741775",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 DEMING DR",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253141013",
"telephone_number": "304-388-2238",
"fax_number": "304-388-2618"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "830 PENNSYLVANIA AVE",
"address_2": "SUITE 406",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253023302",
"telephone_number": "304-388-2238",
"fax_number": "304-388-2618"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHERIDAN",
"first_name": "MARY",
"credential": "NNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-26",
"last_updated": "2008-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "363LN0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Neonatal",
"state": "WV",
"license": "43685",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charleston, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.