Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 37392 | CO |
Y | 111NI0900X | Internist | 37392 | CO |
N | 207R00000X | Internist | G29929 | CA |
N | 111NI0900X | Internist | G29929 | CA |
NPI | 1003053638 |
---|---|
Provider Name | Dr. Sheldon Gregory Stadnyk |
First Address | Boulder, CO 80303-1478 |
Second Address | Greeley, CO 80631-5154 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2009 |
Last Update Date | 20/01/2009 |