Provider Demographics
NPI:1700854205
Name:SHELTON, RAY MARION (PA)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:MARION
Last Name:SHELTON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3804 WESTBURY CT UNIT 9
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-0971
Mailing Address - Country:US
Mailing Address - Phone:910-717-5553
Mailing Address - Fax:
Practice Address - Street 1:AF THE ARMY WAMC
Practice Address - Street 2:2817 REILLY ROAD MCXC-DPC-FM
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-0001
Practice Address - Country:US
Practice Address - Phone:910-907-7634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005164363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant