MEDICARE: MICHAEL SHEFFIELD PH.D.

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	103TC0700X	Clinical Psychologist	363492-2501	UT
2	103TC0700X	Clinical Psychologist	PSY-903	HI

General Provider Information

NPI Number	:	1598976219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL SHEFFIELD PH.D.

Provider Business Mailing Address
First Line	:	1104 ASHTON AVE
Second Line	:	#112
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-4504
Country	:	US
Telephone Number	:	801-518-1352
Fax Number	:

Provider Business Practice Location Address
First Line	:	1104 ASHTON AVE
Second Line	:	#112
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-4504
Country	:	US
Telephone Number	:	801-518-1352
Fax Number	:

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	07/08/2007

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