Provider Demographics
NPI:1245746536
Name:SHELTON, PAUL ALEXANDER
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ALEXANDER
Last Name:SHELTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 ANNA AVE # B
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-2724
Mailing Address - Country:US
Mailing Address - Phone:330-618-4637
Mailing Address - Fax:
Practice Address - Street 1:1025 ANNA AVE # B
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-2724
Practice Address - Country:US
Practice Address - Phone:330-618-4637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-21
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty