Provider Demographics
NPI:1831673656
Name:SHELTON, AMANDA KATHLEEN (CSFA)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:KATHLEEN
Last Name:SHELTON
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:KATHLEEN
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CST
Mailing Address - Street 1:1725 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47804-4010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1725 N 5TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-4010
Practice Address - Country:US
Practice Address - Phone:812-242-3005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN165941246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant