Provider Demographics
NPI:1003394644
Name:SHELTON, CLARENCE FRANK
Entity Type:Individual
Prefix:MR
First Name:CLARENCE
Middle Name:FRANK
Last Name:SHELTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-0724
Mailing Address - Country:US
Mailing Address - Phone:276-732-9278
Mailing Address - Fax:276-934-6375
Practice Address - Street 1:150 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-0724
Practice Address - Country:US
Practice Address - Phone:276-732-9278
Practice Address - Fax:276-934-6375
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)