Provider Demographics
NPI:1740206416
Name:SHELDON, HAYLEY I (MD)
Entity Type:Individual
Prefix:
First Name:HAYLEY
Middle Name:I
Last Name:SHELDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1450 NW 6035
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55485-6035
Mailing Address - Country:US
Mailing Address - Phone:952-542-8553
Mailing Address - Fax:952-513-6857
Practice Address - Street 1:166 19TH STREET SOUTH
Practice Address - Street 2:SUITE 100
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-2154
Practice Address - Country:US
Practice Address - Phone:320-251-0609
Practice Address - Fax:320-251-3806
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL233862085R0202X
MN515372085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009932395Medicaid
AL009937349Medicaid
AL051534541OtherBLUE CROSS
MS8909562OtherMISSISSIPPI MEDICAID
AL009932405Medicaid
ALP00058043OtherRAILROAD MEDICARE
AL010033CH91600OtherSECTION 1011
AL051515820Medicaid
AL051515823OtherBLUE CROSS
AL009932385Medicaid
AL051515820OtherBLUE CROSS
AL051515821OtherBLUE CROSS
AL051515822OtherBLUE CROSS
AL009932405Medicaid