Healthcare Provider Details

I. General information

NPI: 1851206924
Provider Name (Legal Business Name): SHALDOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5441 S MACADAM AVE STE N
PORTLAND OR
97239-3822
US

IV. Provider business mailing address

5441 S MACADAM AVE STE N
PORTLAND OR
97239-3822
US

V. Phone/Fax

Practice location:
  • Phone: 406-309-6462
  • Fax:
Mailing address:
  • Phone: 406-309-6462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHARLES JENNINGS
Title or Position: OWNER
Credential:
Phone: 406-309-6462