Healthcare Provider Details

I. General information

NPI: 1811429723
Provider Name (Legal Business Name): SHELDON BUCK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 N 20TH AVE
PASCO WA
99301-3393
US

IV. Provider business mailing address

1704 W 31ST AVE
KENNEWICK WA
99337-2891
US

V. Phone/Fax

Practice location:
  • Phone: 509-792-1041
  • Fax: 509-792-1034
Mailing address:
  • Phone: 509-792-1041
  • Fax: 509-792-1034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: