Provider Demographics
NPI:1285788323
Name:SHEEDLO, STEVEN TODD (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:TODD
Last Name:SHEEDLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:657 E BROADWAY BLVD
Mailing Address - Street 2:STE. C
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-4906
Mailing Address - Country:US
Mailing Address - Phone:865-475-9062
Mailing Address - Fax:865-475-9063
Practice Address - Street 1:657 E BROADWAY BLVD
Practice Address - Street 2:STE. C
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760
Practice Address - Country:US
Practice Address - Phone:865-475-9062
Practice Address - Fax:865-475-9063
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN42424207P00000X, 208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3000565Medicaid
TN3000565Medicare PIN
TN3707881Medicare PIN