# SHERIDAN CANNONLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497079081
- **Authorized official:** DR. LISA MARIE CANNON M.D (PHYSICIAN)
- **Authorized official phone:** (201) 251-2525

## Contact information

- **Practice address:** 110 WARREN AVE, HO HO KUS, NJ 07423-1566
- **Practice address phone:** (201) 251-2525
- **Practice address fax:** (201) 251-8488
- **Mailing address:** PO BOX 158, WYCKOFF, NJ 07481-0158
- **Mailing address phone:** (201) 251-2525
- **Mailing address fax:** (201) 251-8488

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | MA69017 | NJ | Yes |

## Other

- **Enumeration date:** 03/25/2010
- **Last updated:** 03/25/2010