Provider Demographics
NPI:1497342844
Name:WHITE, SHELDON FORREST (LAT)
Entity Type:Individual
Prefix:MR
First Name:SHELDON
Middle Name:FORREST
Last Name:WHITE
Suffix:
Gender:M
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4040 COUNTY ROAD 541
Mailing Address - Street 2:
Mailing Address - City:HONDO
Mailing Address - State:TX
Mailing Address - Zip Code:78861-5543
Mailing Address - Country:US
Mailing Address - Phone:512-994-5512
Mailing Address - Fax:
Practice Address - Street 1:4040 COUNTY ROAD 541
Practice Address - Street 2:
Practice Address - City:HONDO
Practice Address - State:TX
Practice Address - Zip Code:78861-5543
Practice Address - Country:US
Practice Address - Phone:512-994-5512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT58292255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer