Provider Demographics
NPI:1134126014
Name:REGENBAUM, SHELDON (MD)
Entity Type:Individual
Prefix:DR
First Name:SHELDON
Middle Name:
Last Name:REGENBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5644 WHIRLAWAY RD
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-7735
Mailing Address - Country:US
Mailing Address - Phone:561-626-4605
Mailing Address - Fax:561-626-4168
Practice Address - Street 1:1500 N DIXIE HWY
Practice Address - Street 2:STE 103
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2715
Practice Address - Country:US
Practice Address - Phone:561-833-8893
Practice Address - Fax:561-833-8939
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0065837208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374949500Medicaid
FL25047ZMedicare ID - Type Unspecified
FL374949500Medicaid