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General NPI Number Information
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NPI Number | 1740450709
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Entity Type | Organization
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Legal Business Name | DR SHELDON H RIFKIN PA
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Dates
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Enumeration Date | 03/06/2008
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Last Update Date | 03/06/2008
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Provider Practice Location Address
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Address Line | 612 NE BENT PADDLE LN
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City | PORT ST LUCIE
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State | FL
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Zip | 34983-3528
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Country | US
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Telephone | 772-465-3613
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Fax | 772-878-4070
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Provider Business Mailing Address
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Address Line | 612 NE BENT PADDLE LN
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City | PORT ST LUCIE
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State | FL
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Zip | 34983-3528
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Country | US
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Telephone | 772-465-3613
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Fax | 772-878-4070
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KATY PURCELL
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Credential |
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Telephone | 772-465-3613
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY2546
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License Number State | FL
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