Healthcare Provider Details

I. General information

NPI: 1265344584
Provider Name (Legal Business Name): SHELDON MOSELEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

882 BOYSEN AVE
SAN LUIS OBISPO CA
93405-1311
US

IV. Provider business mailing address

882 BOYSEN AVE
SAN LUIS OBISPO CA
93405-1311
US

V. Phone/Fax

Practice location:
  • Phone: 805-544-0592
  • Fax:
Mailing address:
  • Phone: 805-544-0592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA9101
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: