Provider Demographics
NPI:1164425740
Name:SHELSO, JOHN H (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:H
Last Name:SHELSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:605-328-6585
Mailing Address - Fax:605-328-6512
Practice Address - Street 1:1600 W 22ND ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1521
Practice Address - Country:US
Practice Address - Phone:605-312-1000
Practice Address - Fax:605-312-1001
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN363532080P0205X
SD39202080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5440119Medicaid
GA694544897AMedicaid
SCQ36354Medicaid
MT0082960Medicaid
AL009992005Medicaid
NY02604722-03Medicaid
IA0587857Medicaid
MS05086744Medicaid
KY64081276Medicaid
OK200031050AMedicaid
IN200513750AMedicaid
MO209076900Medicaid
NM82736863Medicaid
AZ977465Medicaid
ME422400000Medicaid
NC7614234Medicaid
LA1470945Medicaid
AR154141001Medicaid
ME422400000Medicaid