Provider Demographics
NPI:1376057471
Name:SHELTON, DANNY WILBURN I
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:WILBURN
Last Name:SHELTON
Suffix:I
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 1:5737 ARBORWOOD CT APT B
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-3463
Mailing Address - Country:US
Mailing Address - Phone:614-446-6397
Mailing Address - Fax:
Practice Address - Street 1:3770 N HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3525
Practice Address - Country:US
Practice Address - Phone:614-294-7117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator