Provider Demographics
NPI:1417084922
Name:STAUNTON, SHELDON B (MD)
Entity Type:Individual
Prefix:
First Name:SHELDON
Middle Name:B
Last Name:STAUNTON
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 1:1932 HOLIDAY DR
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12304-2215
Mailing Address - Country:US
Mailing Address - Phone:518-374-2887
Mailing Address - Fax:
Practice Address - Street 1:1401 UNION ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-3009
Practice Address - Country:US
Practice Address - Phone:518-381-9202
Practice Address - Fax:518-381-1182
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY095150174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10001969OtherCDPHP IDENTIFICATION #
NY000413018005OtherBS NENY PROVIDER #
NY13105OtherMVP PROVIDER #
NM00381902Medicaid
NY630N01OtherEMPIRE BC PROVIDER #
NYRA8763Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
NM00381902Medicaid