Provider Demographics
NPI:1184720740
Name:MESHULAM, SHELDON (MD)
Entity type:Individual
Prefix:
First Name:SHELDON
Middle Name:
Last Name:MESHULAM
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 1:3798 JANES RD
Mailing Address - Street 2:SUITE 20
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-4753
Mailing Address - Country:US
Mailing Address - Phone:707-826-8225
Mailing Address - Fax:707-826-8238
Practice Address - Street 1:3798 JANES RD
Practice Address - Street 2:SUITE 20
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-4753
Practice Address - Country:US
Practice Address - Phone:707-826-8225
Practice Address - Fax:707-826-8238
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66299207RG0100X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G662990Medicaid
E85134Medicare UPIN
CA00G662990Medicaid