Provider Demographics
NPI:1336674241
Name:SHEDLOCK, NANCY (PSYD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:SHEDLOCK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7544 SUNSET CIR
Mailing Address - Street 2:
Mailing Address - City:ALMOND
Mailing Address - State:NY
Mailing Address - Zip Code:14804-9601
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:134 SENECA ST
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-1324
Practice Address - Country:US
Practice Address - Phone:607-324-1303
Practice Address - Fax:607-324-1346
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022023103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist