Provider Demographics
NPI:1568436947
Name:SHEDLO, NORMAN (OD)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:
Last Name:SHEDLO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6345 RED CEDAR PL
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3830
Mailing Address - Country:US
Mailing Address - Phone:410-764-7018
Mailing Address - Fax:
Practice Address - Street 1:6525 BELCREST RD
Practice Address - Street 2:SUITE 200
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-2003
Practice Address - Country:US
Practice Address - Phone:301-779-2424
Practice Address - Fax:301-779-2775
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1624152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD912502700Medicaid
MDG01739Medicare PIN
MDU77580Medicare UPIN