Provider Demographics
NPI:1497171631
Name:SHELDON, MICHELLE DAVIS (LMT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:DAVIS
Last Name:SHELDON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 N MAIN ST
Mailing Address - Street 2:STE 103
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-3055
Mailing Address - Country:US
Mailing Address - Phone:435-867-8986
Mailing Address - Fax:435-867-6233
Practice Address - Street 1:96 N MAIN ST
Practice Address - Street 2:STE 103
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-3055
Practice Address - Country:US
Practice Address - Phone:435-867-8986
Practice Address - Fax:435-867-6233
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8799356-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist