Provider Demographics
NPI:1356318307
Name:SHELDON, ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:SHELDON
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 1:85 WEST BURNSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453
Mailing Address - Country:US
Mailing Address - Phone:718-483-1270
Mailing Address - Fax:718-228-7471
Practice Address - Street 1:25 EAST 183RD STREET
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453
Practice Address - Country:US
Practice Address - Phone:718-483-1270
Practice Address - Fax:718-228-7471
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101601207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01016012Medicaid
NY101601OtherLICENSE #
NY01016012Medicaid
NY629421Medicare ID - Type Unspecified
NY62942863Medicare Oscar/Certification