Individual
ANGELINA SHERIDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
305 GRADY RD STE B, ETOWAH, TN 37331-1911
(423) 263-0722
Mailing address
396 BRYAN DR, DAYTON, TN 37321-6268
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1295124618
NPI
TN
01
—
13510582
CAQH
TN
05
—
1511366
—
TN
01
—
2699
TN LICENSE
TN
01
—
4207616
BCBS PROVIDER ID
TN
Enumeration date
01/22/2015
Last updated
03/07/2023
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