Provider Demographics
NPI:1053093666
Name:NEWLUN, SHERIDAN NOELLE
Entity type:Individual
Prefix:MRS
First Name:SHERIDAN
Middle Name:NOELLE
Last Name:NEWLUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1098 N CECIL RD APT 225
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-8276
Mailing Address - Country:US
Mailing Address - Phone:509-362-6263
Mailing Address - Fax:
Practice Address - Street 1:1098 N CECIL RD APT 225
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-8276
Practice Address - Country:US
Practice Address - Phone:509-362-6263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist