Provider Demographics
NPI:1801222575
Name:SHELTON, TAMIKA
Entity Type:Individual
Prefix:
First Name:TAMIKA
Middle Name:
Last Name:SHELTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3530 E FLAMINGO RD
Mailing Address - Street 2:STE. 135
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-5069
Mailing Address - Country:US
Mailing Address - Phone:702-570-5421
Mailing Address - Fax:702-570-5062
Practice Address - Street 1:3530 E FLAMINGO RD
Practice Address - Street 2:STE. 135
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5069
Practice Address - Country:US
Practice Address - Phone:702-570-5421
Practice Address - Fax:702-570-5062
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst