Provider Demographics
NPI:1093772774
Name:SHELDON, LAUREL B (AA)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:B
Last Name:SHELDON
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 W CREEK RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2139
Mailing Address - Country:US
Mailing Address - Phone:216-986-1314
Mailing Address - Fax:216-986-1191
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:800-223-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH67000048367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH415033OtherWELLCARE MEDICAID
OH0583328OtherBCMH
OH2703864Medicaid
OH000000232326OtherUNISON
OH2265034Medicaid
OH000000515976OtherANTHEM
OH9533063OtherAETNA
OHP00412592OtherRAILROAD MEDICARE
OH2703864Medicaid