Provider Demographics
NPI:1508224437
Name:STOCK, SHELDON LEIGH (APRN)
Entity Type:Individual
Prefix:
First Name:SHELDON
Middle Name:LEIGH
Last Name:STOCK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 JOLLEY DR STE 203
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-4228
Mailing Address - Country:US
Mailing Address - Phone:860-769-9866
Mailing Address - Fax:
Practice Address - Street 1:35 JOLLEY DR STE 203
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-4228
Practice Address - Country:US
Practice Address - Phone:860-769-9866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-06
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6459363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care