Provider Demographics
NPI:1528184520
Name:SHELTON, DENISE WINECK (MS)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:WINECK
Last Name:SHELTON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8960 LITTLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-3977
Mailing Address - Country:US
Mailing Address - Phone:907-677-3757
Mailing Address - Fax:907-677-3768
Practice Address - Street 1:8960 LITTLE CREEK DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-3977
Practice Address - Country:US
Practice Address - Phone:907-677-3757
Practice Address - Fax:907-677-3768
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK421471171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCM5005Medicaid