Provider Demographics
NPI:1477889400
Name:SHELTON, ELISHA LEIGH (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:ELISHA
Middle Name:LEIGH
Last Name:SHELTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ELISHA
Other - Middle Name:LEIGH
Other - Last Name:HATFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9900 N CENTRAL EXPY
Mailing Address - Street 2:STE 215
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-0929
Mailing Address - Country:US
Mailing Address - Phone:214-396-4950
Mailing Address - Fax:877-423-5360
Practice Address - Street 1:1820 PRESTON PARK BLVD STE 1850
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-3633
Practice Address - Country:US
Practice Address - Phone:972-867-4658
Practice Address - Fax:972-867-8696
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-27
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05818363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant