Provider Demographics
NPI:1760533491
Name:SHELTON, JOHN S (CPO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:SHELTON
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 ASHTON DR STE 201
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2486
Mailing Address - Country:US
Mailing Address - Phone:910-218-2240
Mailing Address - Fax:910-399-5523
Practice Address - Street 1:2800 ASHTON DR STE 201
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2486
Practice Address - Country:US
Practice Address - Phone:910-218-2240
Practice Address - Fax:910-399-5523
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0428POtherBLUECROSSBLUESHIELDNC
NC7705351Medicaid
0782190004Medicare NSC
NC7704336Medicaid
NC1179580001Medicare NSC
NC1179580002Medicare NSC