Provider Demographics
NPI:1386283810
Name:SHEIDE, TROY WILLIAM (PSYD)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:WILLIAM
Last Name:SHEIDE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1516
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54936-1516
Mailing Address - Country:US
Mailing Address - Phone:801-703-6192
Mailing Address - Fax:
Practice Address - Street 1:498 RUGGLES ST
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-3931
Practice Address - Country:US
Practice Address - Phone:801-703-6192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-01
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3698-57103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical