Provider Demographics
NPI:1023037801
Name:SHELDON, KENNETH J (NP)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:J
Last Name:SHELDON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 CLARK RD
Mailing Address - Street 2:
Mailing Address - City:STONY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10980-2319
Mailing Address - Country:US
Mailing Address - Phone:845-429-0676
Mailing Address - Fax:
Practice Address - Street 1:21 CLARK RD
Practice Address - Street 2:
Practice Address - City:STONY POINT
Practice Address - State:NY
Practice Address - Zip Code:10980-2319
Practice Address - Country:US
Practice Address - Phone:845-429-0676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330544-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily