Provider Demographics
NPI:1932200326
Name:ROSS, SHELDON (DPM)
Entity Type:Individual
Prefix:DR
First Name:SHELDON
Middle Name:
Last Name:ROSS
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 1:10109 W OAKLAND PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-6917
Mailing Address - Country:US
Mailing Address - Phone:954-748-9444
Mailing Address - Fax:954-749-8712
Practice Address - Street 1:10109 W OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-6917
Practice Address - Country:US
Practice Address - Phone:954-748-9444
Practice Address - Fax:954-749-8712
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO01131213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0411612-00Medicaid
FL592145203OtherEIN #
FL0411612-00Medicaid
FL592145203OtherEIN #