Provider Demographics
NPI:1043065691
Name:REILLY, BRIGID SHERIDAN (PA-C)
Entity type:Individual
Prefix:
First Name:BRIGID
Middle Name:SHERIDAN
Last Name:REILLY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 INTEGRA VISTAS DR APT 403
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-5427
Mailing Address - Country:US
Mailing Address - Phone:914-255-7339
Mailing Address - Fax:
Practice Address - Street 1:188 INTEGRA VISTAS DR APT 403
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-5427
Practice Address - Country:US
Practice Address - Phone:914-255-7339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant