Provider Demographics
NPI:1609308352
Name:DEAKIN, SHELDON
Entity Type:Individual
Prefix:
First Name:SHELDON
Middle Name:
Last Name:DEAKIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 CANNON ST UNIT 221
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-3262
Mailing Address - Country:US
Mailing Address - Phone:347-780-8775
Mailing Address - Fax:
Practice Address - Street 1:57 CANNON ST UNIT 221
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-3262
Practice Address - Country:US
Practice Address - Phone:347-780-8775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY343900000X343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04336641Medicaid