Provider Demographics
NPI:1669041737
Name:JORDAN, SHELDON (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHELDON
Middle Name:
Last Name:JORDAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 INDIAN SCHOOL RD NE STE 208
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-5200
Mailing Address - Country:US
Mailing Address - Phone:855-385-5246
Mailing Address - Fax:
Practice Address - Street 1:5901 INDIAN SCHOOL RD NE STE 208
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-5200
Practice Address - Country:US
Practice Address - Phone:855-385-5246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician
No170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics