Provider Demographics
NPI:1235891557
Name:SHELTON, ADELINE MERIWETHER (RDN, LD)
Entity Type:Individual
Prefix:
First Name:ADELINE
Middle Name:MERIWETHER
Last Name:SHELTON
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 COUNTY ROAD 405
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-9201
Mailing Address - Country:US
Mailing Address - Phone:662-801-9156
Mailing Address - Fax:
Practice Address - Street 1:95 COUNTY ROAD 405
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-9201
Practice Address - Country:US
Practice Address - Phone:662-801-9156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD-1655133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered