Provider Demographics
NPI:1366504136
Name:LEVIN, SHELDON C (PH D)
Entity Type:Individual
Prefix:DR
First Name:SHELDON
Middle Name:C
Last Name:LEVIN
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3229 PIGNATELLI CRESCENT
Mailing Address - Street 2:
Mailing Address - City:MT. PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466
Mailing Address - Country:US
Mailing Address - Phone:843-216-2535
Mailing Address - Fax:843-216-2528
Practice Address - Street 1:913 BOWMAN RD.
Practice Address - Street 2:BUILDING #2
Practice Address - City:MT. PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3235
Practice Address - Country:US
Practice Address - Phone:843-216-2535
Practice Address - Fax:843-216-2528
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02138103G00000X
SC976103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPS0549Medicaid
SC9868Medicare UPIN
MDH181Medicare UPIN
SCPS0549Medicaid