Provider Demographics
NPI:1285607259
Name:SLOAN, SHELDON KING (PA-C)
Entity type:Individual
Prefix:MR
First Name:SHELDON
Middle Name:KING
Last Name:SLOAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 CAMDEN AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEPORT
Mailing Address - State:CA
Mailing Address - Zip Code:95453-5705
Mailing Address - Country:US
Mailing Address - Phone:707-413-7142
Mailing Address - Fax:
Practice Address - Street 1:925 BEVINS CT
Practice Address - Street 2:
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-9754
Practice Address - Country:US
Practice Address - Phone:707-253-8382
Practice Address - Fax:707-263-1909
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
CAPA19539363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1285607259Medicaid
CA1285607259Medicaid