Provider Demographics
NPI:1811904592
Name:SHELDON, WILLIAM B (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:B
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:PO BOX 926
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29484-0926
Mailing Address - Country:US
Mailing Address - Phone:843-509-6895
Mailing Address - Fax:
Practice Address - Street 1:116 BRIARWOOD LN
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-3708
Practice Address - Country:US
Practice Address - Phone:843-509-6895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2010-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC7456207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC074564Medicaid
D17482Medicare UPIN
D174820281Medicare ID - Type Unspecified