Provider Demographics
NPI:1508462714
Name:SHELTON, SHAWNDA
Entity Type:Individual
Prefix:
First Name:SHAWNDA
Middle Name:
Last Name:SHELTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 PENCADER DR UNIT B
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-3365
Mailing Address - Country:US
Mailing Address - Phone:302-533-5616
Mailing Address - Fax:
Practice Address - Street 1:812 PENCADER DR UNIT B
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-3365
Practice Address - Country:US
Practice Address - Phone:302-533-5616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1786772133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist