MEDICARE: MS. SHEILA NUDELMAN ACSW, BCD

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	1041C0700X	Clinical Social Worker	PRO21427-1	NY
2	1041C0700X	Clinical Social Worker	44SC00526000	NJ

General Provider Information

NPI Number	:	1518982024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHEILA NUDELMAN ACSW, BCD

Provider Business Mailing Address
First Line	:	358 WHITMAN ST
Second Line	:
City	:	HAWORTH
State	:	NJ
Zip	:	07641-1317
Country	:	US
Telephone Number	:	201-387-1958
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 SQUADRON BLVD STE 470
Second Line	:
City	:	NEW CITY
State	:	NY
Zip	:	10956-5258
Country	:	US
Telephone Number	:	845-639-6650
Fax Number	:

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	07/08/2007

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