Provider Demographics
NPI:1053337659
Name:BREEDLOVE, SHERIDYN B (MD)
Entity type:Individual
Prefix:
First Name:SHERIDYN
Middle Name:B
Last Name:BREEDLOVE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 ACTON RD
Mailing Address - Street 2:SUITE 171
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-2940
Mailing Address - Country:US
Mailing Address - Phone:205-978-8245
Mailing Address - Fax:205-978-8249
Practice Address - Street 1:2409 ACTON RD
Practice Address - Street 2:SUITE 171
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-2940
Practice Address - Country:US
Practice Address - Phone:205-978-8245
Practice Address - Fax:205-978-8249
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00018441208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALG28054OtherVIVA HEALTH
AL000079492Medicaid
AL51079492OtherBCBS PROVIDER NUMBER
AL5205238OtherAETNA
AL10720OtherHEALTHSPRING
AL12-10041OtherUNITED HEALTHCARE
ALG28054OtherVIVA HEALTH