Provider Demographics
NPI:1194729863
Name:SHEFF, JORDAN S (DPM)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:S
Last Name:SHEFF
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:392 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-1733
Mailing Address - Country:US
Mailing Address - Phone:401-846-8050
Mailing Address - Fax:401-848-0458
Practice Address - Street 1:392 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-1733
Practice Address - Country:US
Practice Address - Phone:401-846-8050
Practice Address - Fax:401-848-0458
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI293213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIU67123Medicare UPIN
4801940001Medicare NSC
RI489007824Medicare PIN