=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295159580
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHELDON FIREM MA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2014
-----------------------------------------------------
Last Update Date | 02/07/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 GOODRICH CT
-----------------------------------------------------
City | CHARDON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44024-1215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-285-5989
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 GOODRICH CT
-----------------------------------------------------
City | CHARDON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44024-1215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-285-5989
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TS0200X
-----------------------------------------------------
Taxonomy Name | School Psychologist
-----------------------------------------------------
License Number | SP 335
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------