Healthcare Provider Details

I. General information

NPI: 1003061771
Provider Name (Legal Business Name): PRISCILLA WALDO SHELDON M.D., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2008
Last Update Date: 07/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W PRATT ST
BALTIMORE MD
21223-2679
US

IV. Provider business mailing address

1001 W PRATT ST
BALTIMORE MD
21223-2679
US

V. Phone/Fax

Practice location:
  • Phone: 410-962-7180
  • Fax: 410-962-7194
Mailing address:
  • Phone: 410-962-7180
  • Fax: 410-962-7194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberD0093200
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0093200
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: