Healthcare Provider Details

I. General information

NPI: 1922082957
Provider Name (Legal Business Name): SHELDON SIMON D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 10/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 W PARRISH AVE STE 300
OWENSBORO KY
42301-3519
US

IV. Provider business mailing address

1915 W PARRISH AVE STE 300
OWENSBORO KY
42301-3519
US

V. Phone/Fax

Practice location:
  • Phone: 270-683-4844
  • Fax: 270-926-8366
Mailing address:
  • Phone: 270-683-4844
  • Fax: 270-926-8366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number119
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number07000335A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number00119
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: