Provider Demographics
NPI:1265476113
Name:SHELTON, RICHARD KENDALL (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:KENDALL
Last Name:SHELTON
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 1:807 N JUSTICE ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791-3409
Mailing Address - Country:US
Mailing Address - Phone:828-693-0294
Mailing Address - Fax:828-697-5738
Practice Address - Street 1:807 N JUSTICE ST
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-3409
Practice Address - Country:US
Practice Address - Phone:828-693-0294
Practice Address - Fax:828-697-5738
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31071174400000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC75656OtherBCBSNC
NC8975656Medicaid
SCN31071Medicaid
NC75656OtherBCBSNC
NC8975656Medicaid