Provider Demographics
NPI:1386672509
Name:SHELTON, BOBBY LEONARD II (MD)
Entity Type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:LEONARD
Last Name:SHELTON
Suffix:II
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 1:8553 TERRIOR LANE
Mailing Address - Street 2:
Mailing Address - City:NEW KENT
Mailing Address - State:VA
Mailing Address - Zip Code:23124
Mailing Address - Country:US
Mailing Address - Phone:540-538-4447
Mailing Address - Fax:
Practice Address - Street 1:1500 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-5229
Practice Address - Country:US
Practice Address - Phone:757-585-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046246207L00000X
VA0101240641207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010386934Medicaid
VA013107B26Medicare PIN