Provider Demographics
NPI:1104845056
Name:SHELTON, ANNETTE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:MARIE
Last Name:SHELTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2011 E LAMAR BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-7332
Mailing Address - Country:US
Mailing Address - Phone:817-548-0504
Mailing Address - Fax:817-861-8845
Practice Address - Street 1:2011 E LAMAR BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-7332
Practice Address - Country:US
Practice Address - Phone:817-548-0504
Practice Address - Fax:817-861-8845
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG56062084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC21724Medicare UPIN