Provider Demographics
NPI:1740450709
Name:DR SHELDON H RIFKIN PA
Entity type:Organization
Organization Name:DR SHELDON H RIFKIN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATY
Authorized Official - Middle Name:
Authorized Official - Last Name:PURCELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-465-3613
Mailing Address - Street 1:612 NE BENT PADDLE LN
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-3528
Mailing Address - Country:US
Mailing Address - Phone:772-465-3613
Mailing Address - Fax:772-878-4070
Practice Address - Street 1:612 NE BENT PADDLE LN
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-3528
Practice Address - Country:US
Practice Address - Phone:772-465-3613
Practice Address - Fax:772-878-4070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY2546103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74171Medicare UPIN