Provider Demographics
NPI:1033219407
Name:ZELLER, SHELDON HOWARD (DC W/PT PRIVILEGES)
Entity Type:Individual
Prefix:
First Name:SHELDON
Middle Name:HOWARD
Last Name:ZELLER
Suffix:
Gender:M
Credentials:DC W/PT PRIVILEGES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3115 SMITH AVENUE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-4541
Mailing Address - Country:US
Mailing Address - Phone:410-486-4338
Mailing Address - Fax:410-526-5982
Practice Address - Street 1:3115 SMITH AVENUE
Practice Address - Street 2:SUITE B
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-4541
Practice Address - Country:US
Practice Address - Phone:410-486-4338
Practice Address - Fax:410-526-5982
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD501306111N00000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5455030OtherAETNA PPO
MD216738700Medicaid
H178OtherBCBS NATIONAL ACCTS
T3780001OtherFEDERAL BCBS
MDH178OtherMEDICARE PART B
1017054OtherAETNA HMO QPOS
108521OtherEMPLOYER HEALTH PLANS
4400196OtherUNITED HEALTH CARE PPO
5634165OtherCIGNA
395324OtherMAMSI
M990SHOtherBCBS
5455030OtherAETNA PPO