Provider Demographics
NPI:1568625218
Name:DR. SARAH SHELTON LLC
Entity Type:Organization
Organization Name:DR. SARAH SHELTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:270-442-0834
Mailing Address - Street 1:1700 KENTUCKY AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-7705
Mailing Address - Country:US
Mailing Address - Phone:270-442-0834
Mailing Address - Fax:
Practice Address - Street 1:1700 KENTUCKY AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7705
Practice Address - Country:US
Practice Address - Phone:270-442-0834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1477261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11772384OtherCAQH