Provider Demographics
NPI:1457456113
Name:RIFKIN, SHELDON HAROLD (PHD)
Entity Type:Individual
Prefix:
First Name:SHELDON
Middle Name:HAROLD
Last Name:RIFKIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 NE BENT PADDLE LN
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-3528
Mailing Address - Country:US
Mailing Address - Phone:772-465-3613
Mailing Address - Fax:772-878-4070
Practice Address - Street 1:612 NE BENT PADDLE LN
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-3528
Practice Address - Country:US
Practice Address - Phone:772-465-3613
Practice Address - Fax:772-878-4070
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY2546103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74171Medicare ID - Type Unspecified
FLR04034Medicare UPIN