Provider Demographics
NPI:1609043629
Name:SHELTON, ROBERT R (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:R
Last Name:SHELTON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 E MAIN ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92583-4214
Mailing Address - Country:US
Mailing Address - Phone:951-654-4902
Mailing Address - Fax:951-654-1660
Practice Address - Street 1:343 E MAIN ST
Practice Address - Street 2:SUITE 105
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-4214
Practice Address - Country:US
Practice Address - Phone:951-654-2277
Practice Address - Fax:951-654-1660
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2017-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22344103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical