Provider Demographics
NPI:1467480723
Name:ROSS-SHELTON, BRENDA JOYCE (MD)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:JOYCE
Last Name:ROSS-SHELTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 S SUNSET AVE STE 402
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3938
Mailing Address - Country:US
Mailing Address - Phone:626-337-4425
Mailing Address - Fax:626-337-4305
Practice Address - Street 1:1135 S SUNSET AVE STE 402
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3938
Practice Address - Country:US
Practice Address - Phone:626-337-4425
Practice Address - Fax:626-337-4305
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD52050207VX0000X
CAG71304207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G713040Medicaid
CAWG71304AMedicare PIN
CA00G713040Medicaid
MDE926Medicare ID - Type Unspecified