Provider Demographics
NPI:1821133372
Name:SHELTON, ROBERT BURNS JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BURNS
Last Name:SHELTON
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5217 CEDAR CT
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-2005
Mailing Address - Country:US
Mailing Address - Phone:630-852-2457
Mailing Address - Fax:
Practice Address - Street 1:120 OAKBROOK CTR
Practice Address - Street 2:720
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1806
Practice Address - Country:US
Practice Address - Phone:630-368-0122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TB0200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist