Provider Demographics
NPI:1124557707
Name:EDWARDS, SHELDON (MD)
Entity type:Individual
Prefix:
First Name:SHELDON
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4825 KNIGHTSBRIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-4325
Mailing Address - Country:US
Mailing Address - Phone:614-451-9612
Mailing Address - Fax:614-451-2009
Practice Address - Street 1:4825 KNIGHTSBRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-4325
Practice Address - Country:US
Practice Address - Phone:614-451-9612
Practice Address - Fax:614-451-2009
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-07
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.149483207R00000X
171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine