Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | SS005102 | MI |
NPI | 1356483630 |
---|---|
Provider Name | Mr. Steve Randall Sheldon |
First Address | Troy, MI 48085-1306 |
Second Address | Troy, MI 48085-1306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2007 |
Last Update Date | 08/07/2007 |