Provider Demographics
NPI:1447255211
Name:SHELDON, DOUGLAS LEVI (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:LEVI
Last Name:SHELDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 N WASHINGTON AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-1535
Mailing Address - Country:US
Mailing Address - Phone:570-961-5522
Mailing Address - Fax:570-961-5579
Practice Address - Street 1:327 N WASHINGTON AVE
Practice Address - Street 2:STE 200
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1535
Practice Address - Country:US
Practice Address - Phone:570-961-5522
Practice Address - Fax:570-961-5579
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD018001E207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA822422Medicaid
PA072563Medicare ID - Type Unspecified
PA822422Medicaid