Provider Demographics
NPI:1699862920
Name:WEISS, SHELDON PAUL (MD)
Entity type:Individual
Prefix:MR
First Name:SHELDON
Middle Name:PAUL
Last Name:WEISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3857 MONTGOMERY DRIVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405
Mailing Address - Country:US
Mailing Address - Phone:707-523-0250
Mailing Address - Fax:707-525-1119
Practice Address - Street 1:3857 MONTGOMERY DRIVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405
Practice Address - Country:US
Practice Address - Phone:707-523-0250
Practice Address - Fax:707-525-1119
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG18615207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0211917Medicaid
CA00G186150Medicare ID - Type Unspecified
CA0211917Medicaid