Provider Demographics
NPI:1619149630
Name:SHELDON, ADINA A (PA)
Entity Type:Individual
Prefix:
First Name:ADINA
Middle Name:A
Last Name:SHELDON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ADINA
Other - Middle Name:A
Other - Last Name:STANCIK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:8169 128TH ST
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33776-3606
Mailing Address - Country:US
Mailing Address - Phone:727-218-7247
Mailing Address - Fax:
Practice Address - Street 1:6333 54TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-1703
Practice Address - Country:US
Practice Address - Phone:727-548-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104550363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9104550OtherSTATE OF FLORIDA DEPARTMENT OF HEALTH
PAMA052068OtherPA LICENSE #