MEDICARE: MRS. NICOLE J SHELDON L.AC.

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	171100000X	Acupuncturist	198.000812	IL
2	171100000X	Acupuncturist	003047-1	NY

General Provider Information

NPI Number	:	1992021893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE J SHELDON L.AC.

Provider Business Mailing Address
First Line	:	3025 N GREENVIEW AVE
Second Line	:	UNIT L
City	:	CHICAGO
State	:	IL
Zip	:	60657-3148
Country	:	US
Telephone Number	:	917-292-7978
Fax Number	:

Provider Business Practice Location Address
First Line	:	3025 N GREENVIEW AVE
Second Line	:	UNIT L
City	:	CHICAGO
State	:	IL
Zip	:	60657-3148
Country	:	US
Telephone Number	:	917-292-7978
Fax Number	:

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

Provider Enumeration Date	:	04/16/2010
Last Update Date	:	04/16/2010

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