Healthcare Provider Details

I. General information

NPI: 1447255211
Provider Name (Legal Business Name): DOUGLAS LEVI SHELDON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 02/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 N WASHINGTON AVE STE 200
SCRANTON PA
18503-1535
US

IV. Provider business mailing address

327 N WASHINGTON AVE STE 200
SCRANTON PA
18503-1535
US

V. Phone/Fax

Practice location:
  • Phone: 570-961-5522
  • Fax: 570-961-5579
Mailing address:
  • Phone: 570-961-5522
  • Fax: 570-961-5579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD018001E
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier822422
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: