Basic Information
| Provider Information | |||||||||
| NPI: | 1750638870 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHELDON | ||||||||
| FirstName: | THERESA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3355 GLENDALE AVE | ||||||||
| Address2: | FL 3 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436142426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193835334 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6801 MAYFIELD RD | ||||||||
| Address2: | SUITE 537 | ||||||||
| City: | MAYFIELD HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441242270 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4404424452 | ||||||||
| FaxNumber: | 4404420571 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2012 | ||||||||
| LastUpdateDate: | 08/16/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 50.003545 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 50.8083717 | 01 | OH | LICENSE NUMBER | OTHER |