Provider Demographics
NPI:1518269463
Name:SHELDON C. LEVIN PH.D., LLC
Entity Type:Organization
Organization Name:SHELDON C. LEVIN PH.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-834-0406
Mailing Address - Street 1:3229 PIGNATELLI CRES
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-8061
Mailing Address - Country:US
Mailing Address - Phone:410-746-8187
Mailing Address - Fax:843-284-8571
Practice Address - Street 1:309 WINGO WAY
Practice Address - Street 2:SUITE 103
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-1804
Practice Address - Country:US
Practice Address - Phone:843-216-2535
Practice Address - Fax:843-284-8571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-29
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC976103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
9868Medicare PIN