1740206416 NPI number — HAYLEY I SHELDON M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740206416 NPI number — HAYLEY I SHELDON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHELDON
Provider First Name:
HAYLEY
Provider Middle Name:
I
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740206416
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1450 NW 6035
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55485-6035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-542-8553
Provider Business Mailing Address Fax Number:
952-513-6857

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
166 19TH STREET SOUTH
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SARTELL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56377-2154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-251-0609
Provider Business Practice Location Address Fax Number:
320-251-3806
Provider Enumeration Date:
07/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  23386 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 51537 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 009932395 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009937349 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051534541 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 8909562 . This is a "MISSISSIPPI MEDICAID" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 009932405 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00058043 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 010033CH91600 . This is a "SECTION 1011" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051515820 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051515823 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009932385 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051515820 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051515821 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051515822 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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