Provider Demographics
NPI:1407023328
Name:SHELDON MEDICAL LLC
Entity Type:Organization
Organization Name:SHELDON MEDICAL LLC
Other - Org Name:SOUTHWEST REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELDON
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:541-267-5221
Mailing Address - Street 1:490 N 2ND ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2370
Mailing Address - Country:US
Mailing Address - Phone:541-267-5221
Mailing Address - Fax:541-267-5221
Practice Address - Street 1:490 N 2ND ST
Practice Address - Street 2:SUITE C
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2370
Practice Address - Country:US
Practice Address - Phone:541-267-5221
Practice Address - Fax:541-267-5221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10886261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR089037Medicaid
OR047063Medicaid