Provider Demographics
NPI:1265475685
Name:SHELDON, SCOTT A (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:SHELDON
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 1:4692 BROWNSBORO RD
Mailing Address - Street 2:PHYSICIANS ELDERCARE, PA
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3410
Mailing Address - Country:US
Mailing Address - Phone:336-251-1114
Mailing Address - Fax:336-251-1115
Practice Address - Street 1:4692 BROWNSBORO RD
Practice Address - Street 2:PHYSICIANS ELDERCARE, PA
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3410
Practice Address - Country:US
Practice Address - Phone:336-251-1114
Practice Address - Fax:336-251-1115
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200100779207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00345272OtherRR MEDICARE
GA145026OtherBCBS
GAHOSP60OtherMEDICARE GROUP
GACN0368OtherRR MEDICARE GROUP
GA10063298OtherAMERIGROUP
GA374872OtherWELLCARE
GA503998724AMedicaid
GA145026OtherBCBS
GAI28348Medicare UPIN