Provider Demographics
NPI:1083490502
Name:HAYNES, SHELDON (MD (DHM))
Entity Type:Individual
Prefix:DR
First Name:SHELDON
Middle Name:
Last Name:HAYNES
Suffix:
Gender:M
Credentials:MD (DHM)
Other - Prefix:
Other - First Name:DEQUAN'
Other - Middle Name:DR
Other - Last Name:DEQUAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5119 NW KENDALL CT
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66618-1269
Mailing Address - Country:US
Mailing Address - Phone:785-817-1893
Mailing Address - Fax:785-578-0009
Practice Address - Street 1:5119 NW KENDALL CT
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66618-1269
Practice Address - Country:US
Practice Address - Phone:785-817-1893
Practice Address - Fax:785-578-0009
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-01
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS-ASCX12N207Q00000X
KSKS04-641042084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSC23124507Medicaid
KS7495262273OtherSTATE LICENSE NO.
KSBH5617545Medicaid
KSG23123897Medicaid
KSW23124507CMedicaid
KSKS04-64104OtherLICENCE NUMBER