Healthcare Provider Details

I. General information

NPI: 1306106737
Provider Name (Legal Business Name): SHELDON J. NANKIN, M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2012
Last Update Date: 05/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 W. STEWART DR. SUITE 504
ORANGE CA
92868-3854
US

IV. Provider business mailing address

1310 W. STEWART DR. SUITE 504
ORANGE CA
92868-3854
US

V. Phone/Fax

Practice location:
  • Phone: 714-997-2020
  • Fax: 714-997-0322
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG17825
License Number StateCA

VIII. Authorized Official

Name: DR. SHELDON J .NANKIN
Title or Position: PEDIATRIC OPHTHALMOLGIST
Credential: M.D.
Phone: 714-997-2020