Provider Demographics
NPI:1700053063
Name:SHELOW, TONI LEE (EDS, PSYD)
Entity Type:Individual
Prefix:DR
First Name:TONI
Middle Name:LEE
Last Name:SHELOW
Suffix:
Gender:F
Credentials:EDS, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 WILSON LN
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-9722
Mailing Address - Country:US
Mailing Address - Phone:828-222-6048
Mailing Address - Fax:828-544-1201
Practice Address - Street 1:7 WILSON LN
Practice Address - Street 2:
Practice Address - City:FLETCHER
Practice Address - State:NC
Practice Address - Zip Code:28732-9722
Practice Address - Country:US
Practice Address - Phone:828-222-6048
Practice Address - Fax:828-544-1201
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6668103G00000X, 103T00000X, 103TC2200X
NC3479103G00000X, 103TC2200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU0590Medicare PIN