Provider Demographics
NPI:1386608123
Name:ROEHMHOLDT, SHELIAH JUNG (MD)
Entity type:Individual
Prefix:DR
First Name:SHELIAH
Middle Name:JUNG
Last Name:ROEHMHOLDT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6044 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6883
Mailing Address - Country:US
Mailing Address - Phone:716-633-6988
Mailing Address - Fax:
Practice Address - Street 1:6044 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6883
Practice Address - Country:US
Practice Address - Phone:716-633-6988
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1819391208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics