Provider Demographics
NPI:1154066116
Name:SHELTON, TINORRA YVONNE
Entity Type:Individual
Prefix:
First Name:TINORRA
Middle Name:YVONNE
Last Name:SHELTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 KATHERINE AVE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-1222
Mailing Address - Country:US
Mailing Address - Phone:151-322-8511
Mailing Address - Fax:
Practice Address - Street 1:505 KATHERINE AVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-1222
Practice Address - Country:US
Practice Address - Phone:151-322-8511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide