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NPI Code Detail

MEDICARE: SHEILA C EDELSON

MEDICARE: SHEILA C EDELSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice DentistryDN010724GA
21223G0001XGeneral Practice Dentistry3350WI

General Provider Information

NPI Number : 1356432074
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHEILA C EDELSON
Provider Business Mailing Address
First Line : 415 N GRAND AVE
Second Line :
City : PUEBLO
State : CO
Zip : 81003-3111
Country : US
Telephone Number : 719-546-3333
Fax Number :
Provider Business Practice Location Address
First Line : 3050 MARTIN LUTHER KING JR DR SW
Second Line : SUITE A
City : ATLANTA
State : GA
Zip : 30311-1500
Country : US
Telephone Number : 404-696-3163
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2006
Last Update Date : 07/09/2007

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Directions to “ SHEILA C EDELSON ” Practice Location

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