Provider Demographics
NPI:1669692844
Name:WERNOW, SHELDON F (DPM)
Entity type:Individual
Prefix:DR
First Name:SHELDON
Middle Name:F
Last Name:WERNOW
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9397 SAN JOSE BOULEVARD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-5587
Mailing Address - Country:US
Mailing Address - Phone:904-731-9293
Mailing Address - Fax:904-636-0223
Practice Address - Street 1:9397 SAN JOSE BOULEVARD
Practice Address - Street 2:SUITE 1
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-5587
Practice Address - Country:US
Practice Address - Phone:904-731-9293
Practice Address - Fax:904-636-0223
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO0001321213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4045212OtherAETNA
FL87708OtherBCBS
FL041144200Medicaid
FL18967OtherHEALTHEASE
FL041144200Medicaid
FLT95175Medicare UPIN
FL87708Medicare PIN