Provider Demographics
NPI:1033229430
Name:SHELDON, SUSAN CAROL (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:CAROL
Last Name:SHELDON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:CAROL
Other - Last Name:SHELDON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:30512 MIRANDELA LN
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2346
Mailing Address - Country:US
Mailing Address - Phone:949-276-8795
Mailing Address - Fax:949-276-8150
Practice Address - Street 1:4100 NEWPORT PLACE DR STE 250
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2437
Practice Address - Country:US
Practice Address - Phone:949-276-8795
Practice Address - Fax:949-276-8150
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8629106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist