Provider Demographics
NPI:1164902318
Name:SHELTON, CLAYTON (PA-C)
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:
Last Name:SHELTON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MARTIN AVE STE 225
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6590
Mailing Address - Country:US
Mailing Address - Phone:630-355-5633
Mailing Address - Fax:
Practice Address - Street 1:10 MARTIN AVE STE 225
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6590
Practice Address - Country:US
Practice Address - Phone:630-355-5633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-17
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty