Provider Demographics
NPI:1235737529
Name:SHELTON, MICHAL A (RD, LDN)
Entity Type:Individual
Prefix:MISS
First Name:MICHAL
Middle Name:A
Last Name:SHELTON
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 KENT RD
Mailing Address - Street 2:
Mailing Address - City:WARMINSTER
Mailing Address - State:PA
Mailing Address - Zip Code:18974-3715
Mailing Address - Country:US
Mailing Address - Phone:267-261-5586
Mailing Address - Fax:
Practice Address - Street 1:5812 LOWER YORK ROAD
Practice Address - Street 2:
Practice Address - City:LAHASKA
Practice Address - State:PA
Practice Address - Zip Code:18931
Practice Address - Country:US
Practice Address - Phone:215-794-7880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA86090887133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered