=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184720740
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHELDON MESHULAM MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2006
-----------------------------------------------------
Last Update Date | 12/30/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3798 JANES RD SUITE 20
-----------------------------------------------------
City | ARCATA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95521-4753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-826-8225
-----------------------------------------------------
Fax | 707-826-8238
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3798 JANES RD SUITE 20
-----------------------------------------------------
City | ARCATA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95521-4753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-826-8225
-----------------------------------------------------
Fax | 707-826-8238
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | G66299
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------