Provider Demographics
NPI:1053791160
Name:SHELDON, LAUREN NICOLE (ATC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:NICOLE
Last Name:SHELDON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:STORRS
Mailing Address - State:CT
Mailing Address - Zip Code:06268-1401
Mailing Address - Country:US
Mailing Address - Phone:860-933-8089
Mailing Address - Fax:
Practice Address - Street 1:17828 SW STATE ROAD 47
Practice Address - Street 2:
Practice Address - City:FORT WHITE
Practice Address - State:FL
Practice Address - Zip Code:32038-3602
Practice Address - Country:US
Practice Address - Phone:860-933-8089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer