MEDICARE: MR. PHILIP C SHEFFIELD JR. M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1306173372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PHILIP C SHEFFIELD JR. M.A.

Provider Business Mailing Address
First Line	:	110 ELMWOOD AVE
Second Line	:	ROOM 125
City	:	BROOKLYN
State	:	NY
Zip	:	11230-2606
Country	:	US
Telephone Number	:	718-859-5420
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 ELMWOOD AVE
Second Line	:	ROOM 125
City	:	BROOKLYN
State	:	NY
Zip	:	11230-2606
Country	:	US
Telephone Number	:	718-859-5420
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2009
Last Update Date	:	11/11/2009

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