Organization
SHERIDAN NEUROLOGY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUE REENE REED (OFFICE MANAGER)
(307) 673-6300
Entity
Organization
Contact information
Practice address
1050 MYDLAND RD, SHERIDAN, WY 82801-2186
(307) 673-6300
(307) 673-6303
Mailing address
1050 MYDLAND RD, SHERIDAN, WY 82801-2186
(307) 673-6300
(307) 673-6303
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
6950A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
119441100
—
WY
05
—
120469600
—
WY
01
—
148019300
FEDERAL WORKERS COMP
WY
01
—
5696001
WY BLUE SHIELD
WI
Enumeration date
01/24/2007
Last updated
01/31/2011
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