Provider Demographics
NPI:1760933089
Name:SHELTON, AMANDA CARESS (NP)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:CARESS
Last Name:SHELTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1833 FOREST DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-4580
Mailing Address - Country:US
Mailing Address - Phone:410-216-9180
Mailing Address - Fax:
Practice Address - Street 1:1901 D ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003
Practice Address - Country:US
Practice Address - Phone:202-698-0400
Practice Address - Fax:202-547-1497
Is Sole Proprietor?:No
Enumeration Date:2016-10-21
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR213837363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily