Provider Demographics
NPI:1942591557
Name:SHELDON, ALISSA JILL (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALISSA
Middle Name:JILL
Last Name:SHELDON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 N FLAMINGO RD
Mailing Address - Street 2:SUITE 213
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1015
Mailing Address - Country:US
Mailing Address - Phone:954-659-0115
Mailing Address - Fax:954-659-0665
Practice Address - Street 1:601 N FLAMINGO RD
Practice Address - Street 2:SUITE 213
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1015
Practice Address - Country:US
Practice Address - Phone:954-659-0115
Practice Address - Fax:954-659-0665
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5578103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPY5578OtherSTATE LICENSURE