Provider Demographics
NPI:1720374358
Name:SHELTON TECHNOLOGIES AND RESOURCES LLC
Entity Type:Organization
Organization Name:SHELTON TECHNOLOGIES AND RESOURCES LLC
Other - Org Name:S.T.A.R.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-603-7827
Mailing Address - Street 1:322 E PINE ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-4969
Mailing Address - Country:US
Mailing Address - Phone:863-603-7827
Mailing Address - Fax:863-603-0255
Practice Address - Street 1:322 E PINE ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-4969
Practice Address - Country:US
Practice Address - Phone:863-603-7827
Practice Address - Fax:863-603-0255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-22
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies