1104002153 NPI number — MRS. JOAN BARBARA SHELDEN P.T.

Table of content: MRS. JOAN BARBARA SHELDEN P.T. (NPI 1104002153)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104002153 NPI number — MRS. JOAN BARBARA SHELDEN P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHELDEN
Provider First Name:
JOAN
Provider Middle Name:
BARBARA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHNEIDER
Provider Other First Name:
JOAN
Provider Other Middle Name:
BARBARA
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1104002153
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6167 W QUAKER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORCHARD PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14127-2640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-662-4800
Provider Business Mailing Address Fax Number:
716-662-5700

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6167 W QUAKER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORCHARD PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14127-2640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-662-4800
Provider Business Practice Location Address Fax Number:
716-662-5700
Provider Enumeration Date:
01/20/2008

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: 174400000X , with the licence number:  4532 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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