Provider Demographics
NPI:1114931011
Name:BAUER SHELDON, MELISSA A (DO)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:A
Last Name:BAUER SHELDON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:402 LIPPINCOTT DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4112
Mailing Address - Country:US
Mailing Address - Phone:856-782-3300
Mailing Address - Fax:856-504-8029
Practice Address - Street 1:132 GROVE ST
Practice Address - Street 2:STE A
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033
Practice Address - Country:US
Practice Address - Phone:856-354-2211
Practice Address - Fax:856-354-6181
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB07153500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0123676Medicaid
077356 SK3Medicare PIN
H80232Medicare UPIN