Provider Demographics
NPI:1750638870
Name:SHELDON, THERESA MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIE
Last Name:SHELDON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3355 GLENDALE AVE
Mailing Address - Street 2:FL 3
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2426
Mailing Address - Country:US
Mailing Address - Phone:419-383-5334
Mailing Address - Fax:
Practice Address - Street 1:6801 MAYFIELD RD
Practice Address - Street 2:SUITE 537
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2270
Practice Address - Country:US
Practice Address - Phone:440-442-4452
Practice Address - Fax:440-442-0571
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH50.003545363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH50.8083717OtherLICENSE NUMBER