Provider Demographics
NPI:1083307623
Name:SHELTON, DARRELL RAY II
Entity Type:Individual
Prefix:
First Name:DARRELL
Middle Name:RAY
Last Name:SHELTON
Suffix:II
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 1:4207 E 64TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-1651
Mailing Address - Country:US
Mailing Address - Phone:539-292-2908
Mailing Address - Fax:
Practice Address - Street 1:4207 E 64TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-1651
Practice Address - Country:US
Practice Address - Phone:539-292-2908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist