Provider Demographics
NPI:1992021893
Name:SHELDON, NICOLE J (LAC)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:J
Last Name:SHELDON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 N GREENVIEW AVE
Mailing Address - Street 2:UNIT L
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3148
Mailing Address - Country:US
Mailing Address - Phone:917-292-7978
Mailing Address - Fax:
Practice Address - Street 1:3025 N GREENVIEW AVE
Practice Address - Street 2:UNIT L
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3148
Practice Address - Country:US
Practice Address - Phone:917-292-7978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-16
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.000812171100000X
NY003047-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist