Provider Demographics
NPI:1104042241
Name:STATLENDER, SHEILA MARILYN (PHD)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:MARILYN
Last Name:STATLENDER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 LANTERN RD
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-5538
Mailing Address - Country:US
Mailing Address - Phone:617-965-2329
Mailing Address - Fax:508-370-3926
Practice Address - Street 1:53 LANGLEY RD
Practice Address - Street 2:SUITE 330C
Practice Address - City:NEWTON CENTRE
Practice Address - State:MA
Practice Address - Zip Code:02459-1913
Practice Address - Country:US
Practice Address - Phone:617-965-2329
Practice Address - Fax:508-370-3926
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3878103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WO3902Medicare ID - Type UnspecifiedPROVIDER NUMBER