Provider Demographics
NPI:1033583653
Name:SHELTON PROSTHETICS AND ORTHOTICS
Entity Type:Organization
Organization Name:SHELTON PROSTHETICS AND ORTHOTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROSTHETIST/ORTHOTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:SOUTHALL
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:910-520-0163
Mailing Address - Street 1:617 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-0217
Mailing Address - Country:US
Mailing Address - Phone:910-520-0163
Mailing Address - Fax:
Practice Address - Street 1:2800 ASHTON DR
Practice Address - Street 2:201
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2575
Practice Address - Country:US
Practice Address - Phone:910-520-0163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-19
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty