Provider Demographics
NPI:1114095668
Name:SHELTON, DIANE RENE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:RENE
Last Name:SHELTON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:DIANE
Other - Middle Name:RENE
Other - Last Name:SHELTON-MCBRYDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:2205 W. 136TH AVENUE
Mailing Address - Street 2:SUITE 106-131
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023
Mailing Address - Country:US
Mailing Address - Phone:720-328-8138
Mailing Address - Fax:
Practice Address - Street 1:2205 W. 136TH AVENUE
Practice Address - Street 2:SUITE 106-131
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80023-8002
Practice Address - Country:US
Practice Address - Phone:720-328-8138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2374103TC0700X
AZ3585103TC0700X
CAPSY24661103TC0700X
FLPY9759103TC0700X
CT3231103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical