Provider Demographics
NPI:1740300680
Name:SHELDON, KENNETH LEE (EDD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:LEE
Last Name:SHELDON
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 RIDGEMEADOW LN
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27803-1227
Mailing Address - Country:US
Mailing Address - Phone:252-937-4977
Mailing Address - Fax:
Practice Address - Street 1:1033 RIDGEMEADOW LN
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27803-1227
Practice Address - Country:US
Practice Address - Phone:252-937-4977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1573103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist