Provider Demographics
NPI:1629587134
Name:SHEIDLEY, BETH ROSEN (MS, CGC)
Entity type:Individual
Prefix:MS
First Name:BETH
Middle Name:ROSEN
Last Name:SHEIDLEY
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOSTON CHILDREN'S HOSPITAL, DEPARTMENT OF NEUROLOGY
Mailing Address - Street 2:3 BLACKFAN CIRCLE, MAIL STOP BCH3149/CLS 14008
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5713
Mailing Address - Country:US
Mailing Address - Phone:857-218-5533
Mailing Address - Fax:
Practice Address - Street 1:3 BLACKFAN CIR
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5713
Practice Address - Country:US
Practice Address - Phone:857-218-5533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAGC021170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAGC021OtherBOARD OF REGISTRATION OF GENETIC COUNSELORS, COMMONWEALTH OF MA