Provider Demographics
NPI:1245670538
Name:SHELDON BULLOCK
Entity type:Organization
Organization Name:SHELDON BULLOCK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SHELDON
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:BULLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, HS-BCP
Authorized Official - Phone:215-728-4688
Mailing Address - Street 1:8220 CASTOR AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-2729
Mailing Address - Country:US
Mailing Address - Phone:215-728-4688
Mailing Address - Fax:
Practice Address - Street 1:8220 CASTOR AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-2729
Practice Address - Country:US
Practice Address - Phone:215-728-4688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health