Provider Demographics
NPI:1922012699
Name:BLACK, SHELDON J (MD)
Entity Type:Individual
Prefix:DR
First Name:SHELDON
Middle Name:J
Last Name:BLACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 SAINT VINCENTS DR
Mailing Address - Street 2:POB# 3 SUITE 402
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1606
Mailing Address - Country:US
Mailing Address - Phone:205-933-9236
Mailing Address - Fax:205-933-9213
Practice Address - Street 1:833 SAINT VINCENTS DR
Practice Address - Street 2:POB# 3 SUITE 402
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1606
Practice Address - Country:US
Practice Address - Phone:205-933-9236
Practice Address - Fax:205-933-9213
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18338207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000022986Medicaid
AL000022986Medicare PIN
ALE84665Medicare UPIN