Provider Demographics
NPI:1346551066
Name:DURUISSEAU, SHELTON (DR)
Entity Type:Individual
Prefix:
First Name:SHELTON
Middle Name:
Last Name:DURUISSEAU
Suffix:
Gender:M
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4528 GRESHAM DR
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-7640
Mailing Address - Country:US
Mailing Address - Phone:916-810-9910
Mailing Address - Fax:
Practice Address - Street 1:4528 GRESHAM DR
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-7640
Practice Address - Country:US
Practice Address - Phone:916-810-9910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health