Provider Demographics
NPI:1164195749
Name:SHELTON, SHANANDRIA (NP)
Entity Type:Individual
Prefix:
First Name:SHANANDRIA
Middle Name:
Last Name:SHELTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SHANANDRIA
Other - Middle Name:
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1542 HEARTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77384-1418
Mailing Address - Country:US
Mailing Address - Phone:936-242-5682
Mailing Address - Fax:
Practice Address - Street 1:3550 NORMAND DR
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-6399
Practice Address - Country:US
Practice Address - Phone:888-393-0391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1046259363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health